| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
11,099 |
10,316 |
$419K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
3,850 |
3,585 |
$294K |
| A4623 |
Tracheostomy, inner cannula |
4,558 |
4,419 |
$202K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12,062 |
11,184 |
$144K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
8,643 |
7,890 |
$122K |
| 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 |
4,097 |
3,825 |
$102K |
| 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 |
923 |
888 |
$93K |
| A4452 |
Tape, waterproof, per 18 square inches |
11,217 |
10,558 |
$76K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,745 |
4,603 |
$71K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,962 |
4,664 |
$59K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,944 |
2,851 |
$58K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,677 |
1,598 |
$42K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,436 |
9,770 |
$28K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,089 |
1,005 |
$23K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,473 |
3,328 |
$18K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
834 |
785 |
$17K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
954 |
888 |
$17K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
1,120 |
1,056 |
$13K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
445 |
414 |
$10K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
630 |
600 |
$9K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
737 |
697 |
$9K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
955 |
922 |
$7K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
153 |
141 |
$6K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,677 |
1,606 |
$5K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
212 |
203 |
$4K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
526 |
503 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,222 |
2,080 |
$3K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
125 |
120 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
3,297 |
3,153 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
779 |
742 |
$2K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,101 |
1,062 |
$2K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
345 |
319 |
$2K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
80 |
78 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
104 |
99 |
$1K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
154 |
150 |
$1K |
| 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 |
102 |
90 |
$867.67 |
| B9002 |
Enteral nutrition infusion pump, any type |
271 |
266 |
$678.81 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
75 |
72 |
$285.31 |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
27 |
25 |
$220.06 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
160 |
147 |
$202.70 |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
12 |
12 |
$111.08 |
| E0776 |
Iv pole |
508 |
506 |
$99.21 |