| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4245 |
Alcohol wipes, per box |
4,869 |
4,783 |
$348K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
3,055 |
3,004 |
$246K |
| A4554 |
Disposable underpads, all sizes |
3,366 |
3,293 |
$203K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,649 |
1,633 |
$200K |
| A4927 |
Gloves, non-sterile, per 100 |
3,157 |
3,082 |
$50K |
| A4928 |
Surgical mask, per 20 |
2,308 |
2,275 |
$40K |
| S5199 |
Personal care item, nos, each |
1,541 |
1,511 |
$36K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
296 |
289 |
$36K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
401 |
401 |
$31K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
107 |
107 |
$17K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
209 |
206 |
$11K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
64 |
62 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
138 |
135 |
$3K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
13 |
12 |
$3K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
48 |
48 |
$2K |