| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Non-sterile gloves |
1,787,194 |
1,714,710 |
$26.39M |
| T4534 |
Youth size pull-on |
344,106 |
323,456 |
$24.77M |
| T4526 |
Adult size pull-on med |
380,823 |
357,645 |
$22.85M |
| T4527 |
Adult size pull-on lg |
344,188 |
322,425 |
$21.66M |
| T4535 |
Disposable liner/shield/pad |
759,118 |
714,275 |
$21.38M |
| T4528 |
Adult size pull-on xl |
271,081 |
252,749 |
$19.98M |
| T4541 |
Large disposable underpad |
1,125,867 |
1,065,811 |
$19.00M |
| A9276 |
Disposable sensor, cgm sys |
65,681 |
48,322 |
$16.79M |
| T4533 |
Youth size brief/diaper |
185,705 |
175,751 |
$12.40M |
| K0553 |
Ther cgm supply allowance |
48,468 |
44,635 |
$11.70M |
| T4522 |
Adult size brief/diaper med |
194,720 |
184,879 |
$11.30M |
| E0784 |
Ext amb infusn pump insulin |
2,939 |
2,828 |
$10.02M |
| T4523 |
Adult size brief/diaper lg |
145,353 |
137,754 |
$9.76M |
| A4351 |
Straight tip urine catheter |
93,774 |
84,591 |
$9.47M |
| T4544 |
Adlt disp und/pull on abv xl |
97,120 |
90,182 |
$8.78M |
| A4230 |
Infus insulin pump non needl |
77,746 |
69,657 |
$8.52M |
| A4239 |
Non-adju cgm supply allow |
32,191 |
29,506 |
$8.20M |
| T4525 |
Adult size pull-on sm |
118,212 |
111,425 |
$7.40M |
| T4521 |
Adult size brief/diaper sm |
96,961 |
91,775 |
$5.94M |
| T4524 |
Adult size brief/diaper xl |
66,289 |
62,788 |
$5.77M |
| A4253 |
Blood glucose/reagent strips |
149,421 |
134,047 |
$5.50M |
| A4353 |
Intermittent urinary cath |
12,329 |
10,430 |
$5.14M |
| T4537 |
Reusable underpad bed size |
213,829 |
197,992 |
$4.97M |
| T4543 |
Adult disp brief/diap abv xl |
32,911 |
30,928 |
$4.73M |
| A9274 |
Ext amb insulin delivery sys |
10,003 |
9,045 |
$4.24M |
| A4352 |
Coude tip urinary catheter |
15,275 |
13,686 |
$3.88M |
| A9277 |
External transmitter, cgm |
6,674 |
5,989 |
$3.20M |
| S5199 |
Personal care item nos each |
427,130 |
422,265 |
$3.04M |
| A4232 |
Syringe w/needle insulin 3cc |
77,442 |
68,923 |
$2.23M |
| T4530 |
Ped size brief/diaper lg |
26,305 |
24,839 |
$1.58M |
| E0603 |
Electric breast pump |
11,637 |
11,470 |
$1.46M |
| A9999 |
Dme supply or accessory, nos |
17,800 |
16,984 |
$1.27M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
9,869 |
8,217 |
$1.26M |
| T4532 |
Ped size pull-on lg |
14,523 |
13,787 |
$1.04M |
| B4150 |
Ef complet w/intact nutrient |
9,818 |
8,281 |
$860K |
| A4554 |
Disposable underpads |
21,551 |
17,806 |
$732K |
| A6250 |
Skin seal protect moisturizr |
201,642 |
193,691 |
$717K |
| A4520 |
Incontinence garment anytype |
24,686 |
23,090 |
$578K |
| A4385 |
Ost skn barrier sld ext wear |
11,837 |
10,291 |
$484K |
| A9278 |
External receiver, cgm sys |
1,246 |
1,084 |
$483K |
| A4259 |
Lancets per box |
123,088 |
104,561 |
$445K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,485 |
2,931 |
$443K |
| K0554 |
Ther cgm receiver/monitor |
1,972 |
1,831 |
$432K |
| A4206 |
1 cc sterile syringe&needle |
10,398 |
5,950 |
$411K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
8,803 |
7,967 |
$378K |
| A4409 |
Ost skn barr convex <=4 sq i |
6,934 |
6,185 |
$365K |
| A4407 |
Ext wear ost skn barr <=4sq" |
4,584 |
4,027 |
$284K |
| A4362 |
Solid skin barrier |
7,663 |
6,896 |
$277K |
| A4349 |
Disposable male external cat |
11,259 |
9,943 |
$271K |
| B4154 |
Ef spec metabolic noninherit |
1,858 |
1,447 |
$262K |
| A4425 |
Ost pch drain for barrier fl |
6,972 |
6,417 |
$248K |
| T4531 |
Ped size pull-on sm/med |
3,559 |
3,319 |
$241K |
| A4231 |
Infusion insulin pump needle |
4,014 |
3,353 |
$219K |
| A4256 |
Calibrator solution/chips |
49,671 |
42,189 |
$215K |
| A4670 |
Automatic bp monitor, dial |
3,558 |
3,120 |
$210K |
| A4344 |
Cath indw foley 2 way silicn |
6,056 |
4,560 |
$206K |
| A4357 |
Bedside drainage bag |
33,717 |
28,913 |
$206K |
| A5063 |
Drain ostomy pouch w/flange |
8,340 |
7,446 |
$197K |
| A4402 |
Lubricant per ounce |
77,687 |
72,340 |
$193K |
| A4456 |
Adhesive remover, wipes |
11,463 |
10,449 |
$191K |
| B4036 |
Enteral feed sup kit grav by |
2,974 |
2,407 |
$179K |
| A4310 |
Insert tray w/o bag/cath |
13,354 |
10,762 |
$172K |
| A4335 |
Incontinence supply |
10,212 |
7,136 |
$172K |
| A4358 |
Urinary leg or abdomen bag |
20,524 |
18,097 |
$172K |
| A5120 |
Skin barrier, wipe or swab |
23,722 |
21,692 |
$163K |
| A4238 |
Adju cgm supply allowance |
829 |
818 |
$156K |
| A6257 |
Transparent film <= 16 sq in |
13,563 |
12,132 |
$149K |
| E2103 |
Non-adju cgm receiver/mon |
742 |
690 |
$141K |
| T5999 |
Supply, nos |
16,726 |
15,755 |
$137K |
| A4388 |
Drainable pch w ex wear barr |
1,920 |
1,740 |
$109K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,685 |
1,280 |
$107K |
| A4394 |
Ostomy pouch liq deodorant |
8,646 |
8,048 |
$107K |
| A4215 |
Sterile needle |
4,701 |
3,816 |
$107K |
| B4034 |
Enter feed supkit syr by day |
1,714 |
1,462 |
$105K |
| A4432 |
Os pch urine w bar/fange/tap |
3,214 |
2,852 |
$94K |
| A4452 |
Waterproof tape |
11,027 |
9,976 |
$91K |
| K0552 |
Sup/ext non-ins inf pump syr |
4,128 |
4,034 |
$83K |
| A4224 |
Supply insulin inf cath/wk |
3,542 |
1,895 |
$82K |
| T1999 |
Noc retail items andsupplies |
1,319 |
1,255 |
$77K |
| A4424 |
Ost pch drain w bar & filter |
1,403 |
1,303 |
$70K |
| A4406 |
Pectin based ostomy paste |
8,511 |
7,782 |
$68K |
| A4389 |
Drainable pch w st wear barr |
812 |
711 |
$67K |
| T4542 |
Small disposable underpad |
6,136 |
5,718 |
$65K |
| A5061 |
Pouch drainable w barrier at |
1,971 |
1,786 |
$58K |
| A4338 |
Indwelling catheter latex |
8,233 |
6,949 |
$58K |
| A4322 |
Irrigation syringe |
9,665 |
8,921 |
$56K |
| E0607 |
Blood glucose monitor home |
732 |
651 |
$51K |
| T4536 |
Reusable pull-on any size |
7,009 |
6,604 |
$47K |
| B4035 |
Enteral feed supp pump per d |
313 |
276 |
$46K |
| A4398 |
Ostomy irrigation bag |
4,654 |
4,434 |
$45K |
| A4314 |
Cath w/drainage 2-way latex |
4,562 |
4,142 |
$45K |
| A4331 |
Extension drainage tubing |
13,444 |
11,425 |
$45K |
| A4320 |
Irrigation tray |
4,625 |
4,202 |
$36K |
| A4419 |
Ost pch for bar w flange/flt |
1,026 |
902 |
$36K |
| A4315 |
Cath w/drainage 2-way silcne |
1,280 |
1,106 |
$36K |
| A4399 |
Ostomy irrig cone/cath w brs |
4,362 |
4,152 |
$32K |
| E1639 |
Scale, each |
1,248 |
893 |
$32K |
| A4247 |
Betadine/iodine swabs/wipes |
2,300 |
2,024 |
$29K |
| A4649 |
Surgical supplies |
158 |
158 |
$27K |
| A6402 |
Sterile gauze <= 16 sq in |
4,796 |
4,328 |
$27K |
| A4371 |
Skin barrier powder per oz |
10,893 |
10,096 |
$26K |
| A5057 |
1 pc ost pou w built-in conv |
439 |
352 |
$26K |
| A5056 |
1 pc ost pouch w filter |
627 |
514 |
$24K |
| T4539 |
Reuse diaper/brief any size |
1,256 |
1,124 |
$24K |
| A4245 |
Alcohol wipes per box |
12,647 |
9,089 |
$24K |
| A5121 |
Solid skin barrier 6x6 |
625 |
552 |
$24K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
246 |
222 |
$23K |
| A4367 |
Ostomy belt |
5,834 |
5,380 |
$23K |
| A4332 |
Lube sterile packet |
3,699 |
3,082 |
$21K |
| A6446 |
Conform band s w>=3" <5"/yd |
482 |
434 |
$20K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
100 |
90 |
$19K |
| A6197 |
Alginate drsg >16 <=48 sq in |
45 |
40 |
$17K |
| A4450 |
Non-waterproof tape |
3,169 |
2,862 |
$17K |
| A4333 |
Urinary cath anchor device |
3,998 |
3,593 |
$17K |
| A4340 |
Indwelling catheter special |
358 |
305 |
$13K |
| A4364 |
Adhesive, liquid or equal |
2,053 |
1,921 |
$13K |
| A4455 |
Adhesive remover per ounce |
1,796 |
1,635 |
$13K |
| A4250 |
Urine reagent strips/tablets |
989 |
974 |
$12K |
| B4087 |
Gastro/jejuno tube, std |
355 |
336 |
$10K |
| A4334 |
Urinary cath leg strap |
6,050 |
5,287 |
$10K |
| A4225 |
Sup/ext insulin inf pump syr |
1,143 |
1,026 |
$9K |
| T2028 |
Special supply, nos waiver |
267 |
258 |
$8K |
| A4390 |
Drainable pch ex wear convex |
140 |
116 |
$7K |
| E0602 |
Manual breast pump |
103 |
103 |
$5K |
| A4373 |
Skin barrier with flange |
80 |
76 |
$5K |
| T4529 |
Ped size brief/diaper sm/med |
75 |
72 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
337 |
327 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
218 |
194 |
$4K |
| A6260 |
Wound cleanser any type/size |
263 |
254 |
$3K |
| A4311 |
Catheter w/o bag 2-way latex |
163 |
132 |
$3K |
| K0603 |
Repl batt alkaline 1.5 v |
3,803 |
3,731 |
$2K |
| A4663 |
Dialysis blood pressure cuff |
653 |
631 |
$2K |
| A9270 |
Non-covered item or service |
3,774 |
3,730 |
$2K |
| A9900 |
Supply/accessory/service |
16 |
14 |
$1K |
| A4427 |
Ost pch drain/barr lk flng/f |
62 |
54 |
$1K |
| A9279 |
Monitoring feature/devicenoc |
13 |
12 |
$1K |
| A4614 |
Hand-held pefr meter |
82 |
77 |
$754.43 |
| A5054 |
Clsd ostomy pouch w/flange |
13 |
13 |
$628.55 |
| B4100 |
Food thickener oral |
15 |
13 |
$539.51 |
| A4258 |
Lancet device each |
63 |
36 |
$148.07 |
| A4233 |
Alkalin batt for glucose mon |
16 |
16 |
$0.00 |
| A4559 |
Coupling gel or paste |
13 |
12 |
$0.00 |