| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
10,292 |
8,292 |
$5.11M |
| A4351 |
Straight tip urine catheter |
14,342 |
11,566 |
$1.65M |
| A4352 |
Coude tip urinary catheter |
3,114 |
2,428 |
$895K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,367 |
1,148 |
$419K |
| A6021 |
Collagen dressing <=16 sq in |
890 |
774 |
$207K |
| A6212 |
Foam drg <=16 sq in w/border |
1,645 |
1,384 |
$202K |
| A6196 |
Alginate dressing <=16 sq in |
1,993 |
1,640 |
$178K |
| A4357 |
Bedside drainage bag |
7,406 |
4,328 |
$114K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,381 |
1,944 |
$110K |
| A6446 |
Conform band s w>=3" <5"/yd |
4,369 |
3,669 |
$106K |
| A4344 |
Cath indw foley 2 way silicn |
1,949 |
702 |
$85K |
| A4358 |
Urinary leg or abdomen bag |
6,377 |
3,659 |
$80K |
| A4452 |
Waterproof tape |
5,391 |
4,467 |
$70K |
| A4310 |
Insert tray w/o bag/cath |
2,713 |
1,482 |
$57K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
490 |
418 |
$57K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
130 |
115 |
$52K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
320 |
275 |
$39K |
| A6402 |
Sterile gauze <= 16 sq in |
6,104 |
5,160 |
$32K |
| A4338 |
Indwelling catheter latex |
1,164 |
838 |
$26K |
| A4402 |
Lubricant per ounce |
6,335 |
5,293 |
$25K |
| A4349 |
Disposable male external cat |
710 |
496 |
$18K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
500 |
424 |
$15K |
| A4314 |
Cath w/drainage 2-way latex |
641 |
551 |
$12K |
| A4554 |
Disposable underpads |
702 |
568 |
$10K |
| A4927 |
Non-sterile gloves |
767 |
631 |
$9K |
| T4526 |
Adult size pull-on med |
205 |
170 |
$9K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
187 |
155 |
$9K |
| T4525 |
Adult size pull-on sm |
168 |
156 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
1,190 |
994 |
$7K |
| T4534 |
Youth size pull-on |
183 |
169 |
$6K |
| A6219 |
Gauze <= 16 sq in w/border |
221 |
204 |
$4K |
| A4332 |
Lube sterile packet |
654 |
521 |
$4K |
| A4322 |
Irrigation syringe |
415 |
311 |
$4K |
| A6457 |
Tubular dressing |
357 |
314 |
$4K |
| T4541 |
Large disposable underpad |
260 |
226 |
$4K |
| A4520 |
Incontinence garment anytype |
145 |
106 |
$4K |
| A6454 |
Self-adher band w>=3" <5"/yd |
100 |
90 |
$3K |
| A4333 |
Urinary cath anchor device |
299 |
241 |
$3K |
| A4315 |
Cath w/drainage 2-way silcne |
33 |
24 |
$1K |
| A6248 |
Hydrogel drsg gel filler |
30 |
24 |
$1K |
| A4239 |
Non-adju cgm supply allow |
15 |
12 |
$994.75 |
| A4450 |
Non-waterproof tape |
284 |
233 |
$787.44 |
| A5120 |
Skin barrier, wipe or swab |
126 |
106 |
$488.13 |
| A6216 |
Non-sterile gauze<=16 sq in |
74 |
64 |
$389.02 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
14 |
12 |
$251.88 |
| A6260 |
Wound cleanser any type/size |
357 |
304 |
$245.29 |
| A4217 |
Sterile water/saline, 500 ml |
22 |
21 |
$63.69 |