| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
11,487 |
10,086 |
$2.50M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
9,137 |
8,251 |
$2.03M |
| T4541 |
Incontinence product, disposable underpad, large, each |
44,489 |
42,206 |
$1.88M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13,050 |
11,279 |
$1.63M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,436 |
12,791 |
$1.23M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
10,671 |
10,163 |
$1.03M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,561 |
1,441 |
$1.01M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,790 |
11,308 |
$963K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
18,911 |
17,822 |
$872K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
10,505 |
9,692 |
$802K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
7,784 |
7,415 |
$763K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,990 |
2,768 |
$710K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
3,938 |
3,319 |
$706K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
6,873 |
6,378 |
$629K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,787 |
2,493 |
$594K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
6,063 |
5,570 |
$569K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,093 |
1,000 |
$556K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,854 |
3,714 |
$514K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
9,317 |
8,552 |
$509K |
| E0784 |
External ambulatory infusion pump, insulin |
767 |
699 |
$489K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
4,824 |
4,331 |
$482K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,313 |
5,973 |
$479K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12,527 |
11,612 |
$453K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
3,289 |
2,938 |
$421K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
9,154 |
8,338 |
$416K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
5,320 |
4,909 |
$407K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,985 |
2,722 |
$393K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
7,395 |
6,883 |
$380K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,911 |
3,767 |
$355K |
| A4927 |
Gloves, non-sterile, per 100 |
30,139 |
27,022 |
$341K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
2,588 |
2,362 |
$265K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
4,960 |
4,496 |
$252K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
4,445 |
4,054 |
$224K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,565 |
3,192 |
$218K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
2,848 |
2,612 |
$200K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,237 |
2,055 |
$198K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,308 |
1,204 |
$188K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22,157 |
20,525 |
$170K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,677 |
1,619 |
$158K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
7,254 |
6,661 |
$155K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,835 |
2,696 |
$152K |
| A4452 |
Tape, waterproof, per 18 square inches |
10,438 |
9,556 |
$151K |
| A5120 |
Skin barrier, wipes or swabs, each |
15,967 |
14,590 |
$145K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
1,808 |
1,618 |
$143K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
1,113 |
1,045 |
$133K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
11,843 |
10,959 |
$132K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
2,585 |
2,394 |
$131K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,061 |
1,847 |
$128K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,079 |
1,985 |
$123K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
1,013 |
919 |
$121K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
2,249 |
2,041 |
$112K |
| A4456 |
Adhesive remover, wipes, any type, each |
14,535 |
13,404 |
$110K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,674 |
1,535 |
$110K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,414 |
1,234 |
$108K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
6,895 |
6,316 |
$103K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,802 |
2,615 |
$102K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
4,746 |
4,287 |
$100K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
1,132 |
982 |
$96K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
2,252 |
2,082 |
$92K |
| A4217 |
Sterile water/saline, 500 ml |
10,864 |
10,088 |
$88K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,339 |
2,143 |
$83K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
448 |
411 |
$74K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
12,271 |
11,291 |
$71K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,951 |
2,720 |
$70K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
1,610 |
1,498 |
$69K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,687 |
3,306 |
$65K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,463 |
1,309 |
$62K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,322 |
2,128 |
$61K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
3,942 |
3,666 |
$58K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
628 |
609 |
$56K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,382 |
2,252 |
$55K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
558 |
521 |
$52K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
832 |
735 |
$51K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
2,102 |
1,982 |
$51K |
| B9998 |
Noc for enteral supplies |
648 |
568 |
$49K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
609 |
547 |
$42K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
668 |
601 |
$41K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
3,140 |
2,924 |
$40K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
4,596 |
4,209 |
$37K |
| A4371 |
Ostomy skin barrier, powder, per oz |
6,401 |
5,953 |
$37K |
| A4367 |
Ostomy belt, each |
4,001 |
3,752 |
$36K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
247 |
239 |
$32K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
363 |
315 |
$32K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
855 |
776 |
$31K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,346 |
1,243 |
$29K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,219 |
1,085 |
$29K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
934 |
853 |
$27K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
898 |
824 |
$26K |
| A4335 |
Incontinence supply; miscellaneous |
2,921 |
2,753 |
$25K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
120 |
116 |
$24K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
476 |
412 |
$23K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
311 |
278 |
$22K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,629 |
1,492 |
$20K |
| A4402 |
Lubricant, per ounce |
2,121 |
1,996 |
$19K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
1,897 |
1,777 |
$14K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
754 |
696 |
$13K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
190 |
184 |
$12K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
136 |
123 |
$12K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
85 |
80 |
$12K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
129 |
121 |
$10K |
| A4396 |
Ostomy belt with peristomal hernia support |
285 |
261 |
$10K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
692 |
607 |
$9K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
347 |
336 |
$8K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
878 |
835 |
$8K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
726 |
643 |
$7K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
571 |
493 |
$6K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
44 |
40 |
$6K |
| A4245 |
Alcohol wipes, per box |
1,099 |
1,028 |
$6K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
122 |
95 |
$5K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
125 |
115 |
$5K |
| A4259 |
Lancets, per box of 100 |
245 |
227 |
$3K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
33 |
27 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
506 |
455 |
$2K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
623 |
534 |
$2K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
16 |
14 |
$2K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
97 |
72 |
$1K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
71 |
67 |
$1K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
179 |
172 |
$1K |
| E1399 |
Durable medical equipment, miscellaneous |
31 |
28 |
$1K |
| A4332 |
Lubricant, individual sterile packet, each |
154 |
144 |
$1K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
116 |
90 |
$1K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
27 |
24 |
$955.45 |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
19 |
17 |
$857.98 |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
16 |
13 |
$840.05 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
15 |
14 |
$795.21 |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
12 |
12 |
$767.40 |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
56 |
53 |
$716.45 |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
12 |
12 |
$633.25 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
41 |
36 |
$539.23 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
69 |
64 |
$429.10 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
14 |
13 |
$326.46 |
| A4246 |
Betadine or phisohex solution, per pint |
18 |
15 |
$153.00 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
13 |
12 |
$24.51 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
29 |
24 |
$20.77 |