| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
70,697 |
64,068 |
$2.36M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
22,492 |
20,323 |
$2.23M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
17,816 |
16,015 |
$1.87M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
21,361 |
19,035 |
$1.70M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
10,365 |
9,122 |
$1.56M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
10,711 |
9,836 |
$1.09M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,612 |
9,759 |
$1.09M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
136,786 |
125,274 |
$1.08M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
9,416 |
8,440 |
$1.01M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,915 |
7,119 |
$632K |
| A4927 |
Gloves, non-sterile, per 100 |
32,498 |
28,962 |
$499K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
23,104 |
21,902 |
$490K |
| 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 |
6,242 |
3,881 |
$455K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,509 |
4,178 |
$411K |
| 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 |
7,394 |
4,868 |
$384K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
4,094 |
3,662 |
$271K |
| 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 |
3,486 |
2,133 |
$189K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,208 |
1,028 |
$138K |
| A5120 |
Skin barrier, wipes or swabs, each |
12,884 |
8,737 |
$130K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,594 |
1,266 |
$121K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,074 |
8,492 |
$43K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,316 |
2,960 |
$42K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,141 |
942 |
$31K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
228 |
162 |
$28K |
| E0776 |
Iv pole |
6,807 |
6,351 |
$26K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,371 |
1,028 |
$25K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
265 |
247 |
$20K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
749 |
581 |
$14K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
637 |
548 |
$11K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,935 |
3,007 |
$10K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,354 |
1,122 |
$10K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
125 |
107 |
$9K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,228 |
1,978 |
$8K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,513 |
1,369 |
$7K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
638 |
438 |
$5K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
307 |
274 |
$2K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,625 |
1,462 |
$2K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
142 |
119 |
$2K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
37 |
24 |
$778.32 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
34 |
30 |
$404.90 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
14 |
12 |
$307.68 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
66 |
51 |
$297.38 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
25 |
25 |
$264.38 |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
88 |
77 |
$243.70 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
26 |
24 |
$238.39 |