| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
11,487 |
10,086 |
$2.50M |
| A4351 |
Straight tip urine catheter |
9,137 |
8,251 |
$2.03M |
| T4541 |
Large disposable underpad |
44,489 |
42,206 |
$1.88M |
| A6212 |
Foam drg <=16 sq in w/border |
13,050 |
11,279 |
$1.63M |
| T4527 |
Adult size pull-on lg |
13,436 |
12,791 |
$1.23M |
| T4528 |
Adult size pull-on xl |
10,671 |
10,163 |
$1.03M |
| A4353 |
Intermittent urinary cath |
1,561 |
1,441 |
$1.01M |
| T4526 |
Adult size pull-on med |
11,790 |
11,308 |
$963K |
| T4535 |
Disposable liner/shield/pad |
18,911 |
17,822 |
$872K |
| A4385 |
Ost skn barrier sld ext wear |
10,505 |
9,692 |
$802K |
| T4523 |
Adult size brief/diaper lg |
7,784 |
7,415 |
$763K |
| A6021 |
Collagen dressing <=16 sq in |
2,990 |
2,768 |
$710K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
3,938 |
3,319 |
$706K |
| A4409 |
Ost skn barr convex <=4 sq i |
6,873 |
6,378 |
$629K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,787 |
2,493 |
$594K |
| A4407 |
Ext wear ost skn barr <=4sq" |
6,063 |
5,570 |
$569K |
| A4352 |
Coude tip urinary catheter |
1,093 |
1,000 |
$556K |
| T4534 |
Youth size pull-on |
3,854 |
3,714 |
$514K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
9,317 |
8,552 |
$509K |
| E0784 |
Ext amb infusn pump insulin |
767 |
699 |
$489K |
| A6196 |
Alginate dressing <=16 sq in |
4,824 |
4,331 |
$482K |
| T4522 |
Adult size brief/diaper med |
6,313 |
5,973 |
$479K |
| A6446 |
Conform band s w>=3" <5"/yd |
12,527 |
11,612 |
$453K |
| A4230 |
Infus insulin pump non needl |
3,289 |
2,938 |
$421K |
| A4362 |
Solid skin barrier |
9,154 |
8,338 |
$416K |
| A6449 |
Lt compres band >=3" <5"/yd |
5,320 |
4,909 |
$407K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,985 |
2,722 |
$393K |
| A4425 |
Ost pch drain for barrier fl |
7,395 |
6,883 |
$380K |
| T4524 |
Adult size brief/diaper xl |
3,911 |
3,767 |
$355K |
| A4927 |
Non-sterile gloves |
30,139 |
27,022 |
$341K |
| A5057 |
1 pc ost pou w built-in conv |
2,588 |
2,362 |
$265K |
| A5063 |
Drain ostomy pouch w/flange |
4,960 |
4,496 |
$252K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
4,445 |
4,054 |
$224K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
3,565 |
3,192 |
$218K |
| A4424 |
Ost pch drain w bar & filter |
2,848 |
2,612 |
$200K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,237 |
2,055 |
$198K |
| T4543 |
Adult disp brief/diap abv xl |
1,308 |
1,204 |
$188K |
| A6216 |
Non-sterile gauze<=16 sq in |
22,157 |
20,525 |
$170K |
| T4530 |
Ped size brief/diaper lg |
1,677 |
1,619 |
$158K |
| A4357 |
Bedside drainage bag |
7,254 |
6,661 |
$155K |
| K0553 |
Ther cgm supply allowance |
2,835 |
2,696 |
$152K |
| A4452 |
Waterproof tape |
10,438 |
9,556 |
$151K |
| A5120 |
Skin barrier, wipe or swab |
15,967 |
14,590 |
$145K |
| A5121 |
Solid skin barrier 6x6 |
1,808 |
1,618 |
$143K |
| A4389 |
Drainable pch w st wear barr |
1,113 |
1,045 |
$133K |
| A6402 |
Sterile gauze <= 16 sq in |
11,843 |
10,959 |
$132K |
| A4419 |
Ost pch for bar w flange/flt |
2,585 |
2,394 |
$131K |
| A6258 |
Transparent film >16<=48 in |
2,061 |
1,847 |
$128K |
| T4525 |
Adult size pull-on sm |
2,079 |
1,985 |
$123K |
| A6199 |
Alginate drsg wound filler |
1,013 |
919 |
$121K |
| A6240 |
Hydrocolld drg filler paste |
2,249 |
2,041 |
$112K |
| A4456 |
Adhesive remover, wipes |
14,535 |
13,404 |
$110K |
| A5056 |
1 pc ost pouch w filter |
1,674 |
1,535 |
$110K |
| A5061 |
Pouch drainable w barrier at |
1,414 |
1,234 |
$108K |
| A4394 |
Ostomy pouch liq deodorant |
6,895 |
6,316 |
$103K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
2,802 |
2,615 |
$102K |
| A4406 |
Pectin based ostomy paste |
4,746 |
4,287 |
$100K |
| A6452 |
High compres band w>=3"<5"yd |
1,132 |
982 |
$96K |
| A6454 |
Self-adher band w>=3" <5"/yd |
2,252 |
2,082 |
$92K |
| A4217 |
Sterile water/saline, 500 ml |
10,864 |
10,088 |
$88K |
| A4322 |
Irrigation syringe |
2,339 |
2,143 |
$83K |
| A4344 |
Cath indw foley 2 way silicn |
448 |
411 |
$74K |
| A4450 |
Non-waterproof tape |
12,271 |
11,291 |
$71K |
| A4310 |
Insert tray w/o bag/cath |
2,951 |
2,720 |
$70K |
| A4432 |
Os pch urine w bar/fange/tap |
1,610 |
1,498 |
$69K |
| A4358 |
Urinary leg or abdomen bag |
3,687 |
3,306 |
$65K |
| A4349 |
Disposable male external cat |
1,463 |
1,309 |
$62K |
| A4338 |
Indwelling catheter latex |
2,322 |
2,128 |
$61K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
3,942 |
3,666 |
$58K |
| E0603 |
Electric breast pump |
628 |
609 |
$56K |
| T4537 |
Reusable underpad bed size |
2,382 |
2,252 |
$55K |
| A4416 |
Ost pch clsd w barrier/filtr |
558 |
521 |
$52K |
| A4253 |
Blood glucose/reagent strips |
832 |
735 |
$51K |
| K0552 |
Sup/ext non-ins inf pump syr |
2,102 |
1,982 |
$51K |
| B9998 |
Enteral supp not otherwise c |
648 |
568 |
$49K |
| A6248 |
Hydrogel drsg gel filler |
609 |
547 |
$42K |
| A4373 |
Skin barrier with flange |
668 |
601 |
$41K |
| A6250 |
Skin seal protect moisturizr |
3,140 |
2,924 |
$40K |
| A4369 |
Skin barrier liquid per oz |
4,596 |
4,209 |
$37K |
| A4371 |
Skin barrier powder per oz |
6,401 |
5,953 |
$37K |
| A4367 |
Ostomy belt |
4,001 |
3,752 |
$36K |
| A4388 |
Drainable pch w ex wear barr |
247 |
239 |
$32K |
| A4410 |
Ost skn barr extnd >4 sq |
363 |
315 |
$32K |
| A4232 |
Syringe w/needle insulin 3cc |
855 |
776 |
$31K |
| A6219 |
Gauze <= 16 sq in w/border |
1,346 |
1,243 |
$29K |
| A4239 |
Non-adju cgm supply allow |
1,219 |
1,085 |
$29K |
| A4427 |
Ost pch drain/barr lk flng/f |
934 |
853 |
$27K |
| A6266 |
Impreg gauze no h20/sal/yard |
898 |
824 |
$26K |
| A4335 |
Incontinence supply |
2,921 |
2,753 |
$25K |
| A9276 |
Disposable sensor, cgm sys |
120 |
116 |
$24K |
| A6450 |
Lt compres band >=5"/yd |
476 |
412 |
$23K |
| A6207 |
Contact layer >16<= 48 sq in |
311 |
278 |
$22K |
| A6217 |
Non-sterile gauze>16<=48 sq |
1,629 |
1,492 |
$20K |
| A4402 |
Lubricant per ounce |
2,121 |
1,996 |
$19K |
| A4455 |
Adhesive remover per ounce |
1,897 |
1,777 |
$14K |
| A4320 |
Irrigation tray |
754 |
696 |
$13K |
| T4521 |
Adult size brief/diaper sm |
190 |
184 |
$12K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
136 |
123 |
$12K |
| B4035 |
Enteral feed supp pump per d |
85 |
80 |
$12K |
| B4088 |
Gastro/jejuno tube, low-pro |
129 |
121 |
$10K |
| A4396 |
Peristomal hernia supprt blt |
285 |
261 |
$10K |
| A4224 |
Supply insulin inf cath/wk |
692 |
607 |
$9K |
| A6261 |
Wound filler gel/paste /oz |
347 |
336 |
$8K |
| A4333 |
Urinary cath anchor device |
878 |
835 |
$8K |
| A6457 |
Tubular dressing |
726 |
643 |
$7K |
| A6441 |
Pad band w>=3" <5"/yd |
571 |
493 |
$6K |
| A4390 |
Drainable pch ex wear convex |
44 |
40 |
$6K |
| A4245 |
Alcohol wipes per box |
1,099 |
1,028 |
$6K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
122 |
95 |
$5K |
| A4364 |
Adhesive, liquid or equal |
125 |
115 |
$5K |
| A4259 |
Lancets per box |
245 |
227 |
$3K |
| A4393 |
Urine pch w ex wear bar conv |
33 |
27 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
506 |
455 |
$2K |
| A4225 |
Sup/ext insulin inf pump syr |
623 |
534 |
$2K |
| A4430 |
Ost urine pch w b/bltin conv |
16 |
14 |
$2K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
97 |
72 |
$1K |
| A6407 |
Packing strips, non-impreg |
71 |
67 |
$1K |
| A4331 |
Extension drainage tubing |
179 |
172 |
$1K |
| E1399 |
Durable medical equipment mi |
31 |
28 |
$1K |
| A4332 |
Lube sterile packet |
154 |
144 |
$1K |
| A4405 |
Nonpectin based ostomy paste |
116 |
90 |
$1K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
27 |
24 |
$955.45 |
| K0554 |
Ther cgm receiver/monitor |
19 |
17 |
$857.98 |
| A6545 |
Grad com non-elastic bk surg |
16 |
13 |
$840.05 |
| A4221 |
Supp non-insulin inf cath/wk |
15 |
14 |
$795.21 |
| A4423 |
Ost pch for bar w lk fl/fltr |
12 |
12 |
$767.40 |
| A6218 |
Non-sterile gauze > 48 sq in |
56 |
53 |
$716.45 |
| A5054 |
Clsd ostomy pouch w/flange |
12 |
12 |
$633.25 |
| A4247 |
Betadine/iodine swabs/wipes |
41 |
36 |
$539.23 |
| A4334 |
Urinary cath leg strap |
69 |
64 |
$429.10 |
| A6445 |
Conform band s w <3"/yd |
14 |
13 |
$326.46 |
| A4246 |
Betadine/phisohex solution |
18 |
15 |
$153.00 |
| A6442 |
Conform band n/s w<3"/yd |
13 |
12 |
$24.51 |
| A4314 |
Cath w/drainage 2-way latex |
29 |
24 |
$20.77 |