| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
101,620 |
99,471 |
$35.99M |
| A4351 |
Straight tip urine catheter |
82,797 |
76,007 |
$21.61M |
| T4541 |
Large disposable underpad |
555,730 |
540,085 |
$16.36M |
| T4535 |
Disposable liner/shield/pad |
359,126 |
345,931 |
$14.98M |
| K0553 |
Ther cgm supply allowance |
44,060 |
43,191 |
$12.61M |
| T4527 |
Adult size pull-on lg |
247,718 |
239,842 |
$11.93M |
| T4526 |
Adult size pull-on med |
266,069 |
257,819 |
$11.54M |
| T4528 |
Adult size pull-on xl |
162,559 |
156,777 |
$9.61M |
| T4523 |
Adult size brief/diaper lg |
110,391 |
107,233 |
$8.41M |
| A4353 |
Intermittent urinary cath |
10,603 |
9,753 |
$6.87M |
| T4534 |
Youth size pull-on |
61,867 |
59,872 |
$6.02M |
| A4352 |
Coude tip urinary catheter |
12,030 |
11,210 |
$5.96M |
| A9276 |
Disposable sensor, cgm sys |
19,854 |
15,723 |
$5.75M |
| T4524 |
Adult size brief/diaper xl |
73,630 |
71,060 |
$5.64M |
| E0784 |
Ext amb infusn pump insulin |
3,856 |
3,685 |
$5.56M |
| T4522 |
Adult size brief/diaper med |
98,035 |
95,278 |
$5.54M |
| A6197 |
Alginate drsg >16 <=48 sq in |
14,820 |
13,658 |
$5.00M |
| T5999 |
Supply, nos |
9,608 |
7,276 |
$4.25M |
| A4385 |
Ost skn barrier sld ext wear |
42,377 |
40,587 |
$4.19M |
| E0603 |
Electric breast pump |
42,705 |
42,343 |
$4.03M |
| A4453 |
Rec cath any transanal, each |
6,930 |
6,735 |
$3.53M |
| A4230 |
Infus insulin pump non needl |
33,310 |
29,127 |
$3.22M |
| E1399 |
Durable medical equipment mi |
14,131 |
13,773 |
$2.82M |
| A4409 |
Ost skn barr convex <=4 sq i |
24,812 |
23,384 |
$2.57M |
| A6212 |
Foam drg <=16 sq in w/border |
19,394 |
17,489 |
$2.48M |
| A4407 |
Ext wear ost skn barr <=4sq" |
15,320 |
14,443 |
$2.23M |
| T4530 |
Ped size brief/diaper lg |
36,349 |
35,197 |
$2.14M |
| E2103 |
Non-adju cgm receiver/mon |
20,455 |
20,232 |
$1.89M |
| T4525 |
Adult size pull-on sm |
41,847 |
40,539 |
$1.74M |
| A4425 |
Ost pch drain for barrier fl |
25,539 |
24,287 |
$1.62M |
| A4344 |
Cath indw foley 2 way silicn |
8,403 |
7,685 |
$1.62M |
| A4927 |
Non-sterile gloves |
196,004 |
187,386 |
$1.46M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
5,876 |
5,271 |
$1.40M |
| A4232 |
Syringe w/needle insulin 3cc |
32,047 |
29,550 |
$1.40M |
| A6021 |
Collagen dressing <=16 sq in |
6,142 |
5,686 |
$1.37M |
| A4362 |
Solid skin barrier |
20,578 |
19,541 |
$1.35M |
| A9277 |
External transmitter, cgm |
2,722 |
2,639 |
$1.33M |
| A5057 |
1 pc ost pou w built-in conv |
6,537 |
6,176 |
$1.18M |
| T4543 |
Adult disp brief/diap abv xl |
8,707 |
8,342 |
$1.17M |
| A6260 |
Wound cleanser any type/size |
28,742 |
27,460 |
$1.09M |
| T4532 |
Ped size pull-on lg |
5,591 |
5,366 |
$1.05M |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
5,868 |
5,327 |
$998K |
| A4322 |
Irrigation syringe |
22,360 |
21,444 |
$966K |
| A6196 |
Alginate dressing <=16 sq in |
7,095 |
6,518 |
$935K |
| A6446 |
Conform band s w>=3" <5"/yd |
29,010 |
26,903 |
$899K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
5,612 |
5,096 |
$788K |
| A4357 |
Bedside drainage bag |
34,619 |
33,004 |
$759K |
| B4035 |
Enteral feed supp pump per d |
7,009 |
6,656 |
$705K |
| B9998 |
Enteral supp not otherwise c |
10,196 |
9,082 |
$697K |
| T4521 |
Adult size brief/diaper sm |
12,920 |
12,557 |
$697K |
| A9278 |
External receiver, cgm sys |
1,366 |
1,322 |
$695K |
| A5056 |
1 pc ost pouch w filter |
7,084 |
6,678 |
$655K |
| A4554 |
Disposable underpads |
60,840 |
47,131 |
$646K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
11,168 |
10,469 |
$634K |
| A6250 |
Skin seal protect moisturizr |
68,752 |
66,196 |
$629K |
| A4310 |
Insert tray w/o bag/cath |
13,548 |
12,641 |
$621K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
7,107 |
6,704 |
$610K |
| A4394 |
Ostomy pouch liq deodorant |
23,071 |
22,060 |
$578K |
| A4349 |
Disposable male external cat |
10,968 |
10,324 |
$576K |
| K0554 |
Ther cgm receiver/monitor |
5,528 |
5,460 |
$574K |
| A4419 |
Ost pch for bar w flange/flt |
7,163 |
6,786 |
$551K |
| A5120 |
Skin barrier, wipe or swab |
49,735 |
47,830 |
$548K |
| T4537 |
Reusable underpad bed size |
24,659 |
24,289 |
$530K |
| A5063 |
Drain ostomy pouch w/flange |
10,310 |
9,862 |
$505K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
916 |
801 |
$478K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
7,086 |
6,610 |
$474K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
5,694 |
5,219 |
$466K |
| B4088 |
Gastro/jejuno tube, low-pro |
4,306 |
4,223 |
$429K |
| A4390 |
Drainable pch ex wear convex |
2,553 |
2,357 |
$418K |
| A9286 |
Any hygienic item, device |
50,428 |
48,224 |
$417K |
| A4358 |
Urinary leg or abdomen bag |
20,832 |
19,700 |
$409K |
| A4410 |
Ost skn barr extnd >4 sq |
2,635 |
2,434 |
$403K |
| A5121 |
Solid skin barrier 6x6 |
3,610 |
3,349 |
$403K |
| A4335 |
Incontinence supply |
58,935 |
57,503 |
$375K |
| B4154 |
Ef spec metabolic noninherit |
6,633 |
4,101 |
$367K |
| A4459 |
Transanal irrigation, any |
2,551 |
2,526 |
$356K |
| A6454 |
Self-adher band w>=3" <5"/yd |
6,085 |
5,685 |
$350K |
| A4320 |
Irrigation tray |
6,415 |
6,102 |
$348K |
| A4388 |
Drainable pch w ex wear barr |
3,926 |
3,754 |
$347K |
| A6402 |
Sterile gauze <= 16 sq in |
33,763 |
32,189 |
$341K |
| A4424 |
Ost pch drain w bar & filter |
3,705 |
3,545 |
$339K |
| A4456 |
Adhesive remover, wipes |
36,122 |
34,952 |
$335K |
| A5061 |
Pouch drainable w barrier at |
3,774 |
3,591 |
$310K |
| A4406 |
Pectin based ostomy paste |
15,293 |
14,792 |
$293K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
5,940 |
5,611 |
$284K |
| A6199 |
Alginate drsg wound filler |
1,651 |
1,526 |
$254K |
| A4389 |
Drainable pch w st wear barr |
2,207 |
2,020 |
$253K |
| A4432 |
Os pch urine w bar/fange/tap |
4,439 |
4,274 |
$252K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,793 |
2,566 |
$250K |
| A6216 |
Non-sterile gauze<=16 sq in |
30,921 |
28,871 |
$235K |
| A4430 |
Ost urine pch w b/bltin conv |
1,575 |
1,510 |
$234K |
| A7048 |
Vacuum drain bottle/tube kit |
195 |
174 |
$228K |
| A4217 |
Sterile water/saline, 500 ml |
10,453 |
10,036 |
$222K |
| A4520 |
Incontinence garment anytype |
22,655 |
20,947 |
$221K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,388 |
2,607 |
$219K |
| A4338 |
Indwelling catheter latex |
7,755 |
7,175 |
$212K |
| A9274 |
Ext amb insulin delivery sys |
680 |
637 |
$203K |
| A6240 |
Hydrocolld drg filler paste |
2,029 |
1,938 |
$178K |
| B4150 |
Ef complet w/intact nutrient |
1,497 |
1,142 |
$176K |
| A4402 |
Lubricant per ounce |
23,632 |
22,881 |
$174K |
| A4452 |
Waterproof tape |
10,189 |
9,016 |
$159K |
| A4416 |
Ost pch clsd w barrier/filtr |
952 |
900 |
$155K |
| A4427 |
Ost pch drain/barr lk flng/f |
2,633 |
2,473 |
$154K |
| A4371 |
Skin barrier powder per oz |
21,316 |
20,672 |
$148K |
| A6258 |
Transparent film >16<=48 in |
2,549 |
2,355 |
$144K |
| A4373 |
Skin barrier with flange |
1,582 |
1,456 |
$139K |
| A4231 |
Infusion insulin pump needle |
1,646 |
1,548 |
$130K |
| A4670 |
Automatic bp monitor, dial |
8,843 |
8,805 |
$129K |
| A4332 |
Lube sterile packet |
9,958 |
9,607 |
$123K |
| A4649 |
Surgical supplies |
1,945 |
1,817 |
$119K |
| A4354 |
Cath insertion tray w/bag |
213 |
205 |
$118K |
| A6449 |
Lt compres band >=3" <5"/yd |
2,098 |
1,834 |
$117K |
| A6219 |
Gauze <= 16 sq in w/border |
5,041 |
4,715 |
$112K |
| A6248 |
Hydrogel drsg gel filler |
2,285 |
2,196 |
$104K |
| A6207 |
Contact layer >16<= 48 sq in |
896 |
800 |
$101K |
| A6457 |
Tubular dressing |
3,738 |
3,446 |
$95K |
| A4367 |
Ostomy belt |
12,069 |
11,700 |
$90K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,463 |
1,356 |
$87K |
| T4533 |
Youth size brief/diaper |
1,744 |
1,693 |
$87K |
| A4253 |
Blood glucose/reagent strips |
1,732 |
1,561 |
$78K |
| A6261 |
Wound filler gel/paste /oz |
1,137 |
1,091 |
$78K |
| A4393 |
Urine pch w ex wear bar conv |
575 |
536 |
$74K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
1,132 |
1,066 |
$73K |
| A5054 |
Clsd ostomy pouch w/flange |
821 |
773 |
$66K |
| A4396 |
Peristomal hernia supprt blt |
1,776 |
1,674 |
$65K |
| A5112 |
Urinary leg bag |
1,857 |
1,727 |
$64K |
| A6545 |
Grad com non-elastic bk surg |
1,257 |
1,040 |
$61K |
| A4333 |
Urinary cath anchor device |
4,059 |
3,897 |
$60K |
| A4455 |
Adhesive remover per ounce |
7,371 |
7,029 |
$60K |
| A4930 |
Sterile, gloves per pair |
710 |
661 |
$60K |
| A4411 |
Ost skn barr extnd =4sq |
721 |
649 |
$60K |
| A4428 |
Urine ost pouch w faucet/tap |
511 |
480 |
$58K |
| T4536 |
Reusable pull-on any size |
4,993 |
4,817 |
$57K |
| T4542 |
Small disposable underpad |
2,064 |
2,045 |
$57K |
| A4340 |
Indwelling catheter special |
595 |
546 |
$56K |
| A4408 |
Ext wear ost skn barr >4sq" |
300 |
285 |
$55K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
2,805 |
2,651 |
$54K |
| A6452 |
High compres band w>=3"<5"yd |
405 |
305 |
$48K |
| A4450 |
Non-waterproof tape |
9,834 |
9,060 |
$46K |
| B4036 |
Enteral feed sup kit grav by |
1,307 |
1,270 |
$45K |
| A4224 |
Supply insulin inf cath/wk |
1,614 |
1,433 |
$43K |
| A4412 |
Ost pouch drain high output |
469 |
450 |
$35K |
| A4369 |
Skin barrier liquid per oz |
7,549 |
7,288 |
$34K |
| A6257 |
Transparent film <= 16 sq in |
1,526 |
1,415 |
$33K |
| A4364 |
Adhesive, liquid or equal |
1,457 |
1,392 |
$32K |
| A4421 |
Ostomy supply misc |
545 |
530 |
$30K |
| A6010 |
Collagen based wound filler |
98 |
93 |
$29K |
| A4334 |
Urinary cath leg strap |
2,396 |
2,280 |
$24K |
| A4225 |
Sup/ext insulin inf pump syr |
1,711 |
1,589 |
$24K |
| A4423 |
Ost pch for bar w lk fl/fltr |
213 |
197 |
$22K |
| A4314 |
Cath w/drainage 2-way latex |
914 |
870 |
$20K |
| A5200 |
Percutaneous catheter anchor |
331 |
313 |
$19K |
| B4161 |
Ef ped hydrolyzed/amino acid |
20 |
17 |
$19K |
| A4331 |
Extension drainage tubing |
2,985 |
2,826 |
$17K |
| A4247 |
Betadine/iodine swabs/wipes |
1,135 |
1,056 |
$16K |
| A4400 |
Ostomy irrigation set |
229 |
220 |
$16K |
| K0552 |
Sup/ext non-ins inf pump syr |
493 |
428 |
$15K |
| A4413 |
2 pc drainable ost pouch |
160 |
145 |
$15K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
68 |
57 |
$15K |
| A6407 |
Packing strips, non-impreg |
294 |
272 |
$15K |
| A6022 |
Collagen drsg>16<=48 sq in |
57 |
53 |
$15K |
| A6445 |
Conform band s w <3"/yd |
676 |
629 |
$13K |
| A9999 |
Dme supply or accessory, nos |
1,014 |
970 |
$13K |
| A9900 |
Supply/accessory/service |
722 |
704 |
$12K |
| A4405 |
Nonpectin based ostomy paste |
1,197 |
1,160 |
$12K |
| B4100 |
Food thickener oral |
167 |
164 |
$12K |
| A5131 |
Appliance cleaner |
1,564 |
1,475 |
$10K |
| A9270 |
Non-covered item or service |
602 |
545 |
$10K |
| A6217 |
Non-sterile gauze>16<=48 sq |
345 |
324 |
$8K |
| A4311 |
Catheter w/o bag 2-way latex |
732 |
694 |
$8K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
180 |
129 |
$8K |
| E0325 |
Urinal male jug-type |
586 |
577 |
$7K |
| A6447 |
Conform band s w >=5"/yd |
177 |
164 |
$7K |
| B4155 |
Ef incomplete/modular |
304 |
178 |
$7K |
| A4245 |
Alcohol wipes per box |
1,629 |
1,585 |
$6K |
| A5114 |
Foam/fabric leg strap |
384 |
368 |
$6K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
255 |
247 |
$5K |
| A6203 |
Composite drsg <= 16 sq in |
159 |
132 |
$5K |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
61 |
60 |
$4K |
| A6441 |
Pad band w>=3" <5"/yd |
266 |
250 |
$4K |
| A4216 |
Sterile water/saline, 10 ml |
154 |
147 |
$4K |
| A4366 |
Ostomy vent |
114 |
109 |
$3K |
| A4326 |
Male external catheter |
15 |
15 |
$3K |
| A4363 |
Ostomy clamp, replacement |
371 |
350 |
$3K |
| A4398 |
Ostomy irrigation bag |
131 |
125 |
$3K |
| A5055 |
Stoma cap |
69 |
62 |
$3K |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
12 |
12 |
$3K |
| A4315 |
Cath w/drainage 2-way silcne |
82 |
81 |
$2K |
| B4034 |
Enter feed supkit syr by day |
48 |
39 |
$2K |
| E0240 |
Bath/shower chair |
59 |
59 |
$2K |
| E0607 |
Blood glucose monitor home |
43 |
43 |
$2K |
| A4259 |
Lancets per box |
736 |
698 |
$2K |
| A6231 |
Hydrogel dsg<=16 sq in |
14 |
12 |
$2K |
| A6442 |
Conform band n/s w<3"/yd |
355 |
326 |
$2K |
| A6218 |
Non-sterile gauze > 48 sq in |
148 |
145 |
$2K |
| A4256 |
Calibrator solution/chips |
275 |
255 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
97 |
97 |
$2K |
| S5199 |
Personal care item nos each |
133 |
117 |
$1K |
| E0105 |
Cane adjust/fixed quad/3 pro |
25 |
25 |
$898.06 |
| E0163 |
Commode chair with fixed arm |
19 |
19 |
$837.71 |
| E0241 |
Bath tub wall rail |
22 |
22 |
$628.00 |
| A6450 |
Lt compres band >=5"/yd |
12 |
12 |
$576.94 |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
15 |
12 |
$460.82 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
15 |
14 |
$277.20 |
| E0100 |
Cane adjust/fixed with tip |
20 |
20 |
$276.18 |