| Code | Description | Claims | Beneficiaries | Total Paid |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
15,905 |
14,709 |
$1.25M |
| 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 |
5,043 |
4,510 |
$1.10M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,269 |
6,714 |
$631K |
| T4541 |
Incontinence product, disposable underpad, large, each |
20,750 |
19,122 |
$543K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,730 |
6,223 |
$540K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,346 |
11,302 |
$463K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,461 |
5,989 |
$456K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,510 |
3,197 |
$385K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
3,835 |
3,461 |
$379K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,581 |
5,174 |
$339K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
10,311 |
9,431 |
$329K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,199 |
1,946 |
$273K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
7,157 |
6,575 |
$272K |
| 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 |
5,920 |
5,376 |
$263K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,748 |
3,339 |
$221K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
905 |
752 |
$217K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
3,797 |
3,460 |
$212K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,585 |
3,321 |
$177K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
765 |
687 |
$168K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,997 |
1,859 |
$166K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,902 |
1,773 |
$141K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
6,364 |
5,848 |
$140K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,837 |
1,717 |
$134K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
1,684 |
1,558 |
$134K |
| A4927 |
Gloves, non-sterile, per 100 |
15,684 |
14,446 |
$133K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,513 |
1,385 |
$127K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,912 |
2,680 |
$123K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
5,772 |
5,246 |
$111K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
1,716 |
1,553 |
$111K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,202 |
1,127 |
$104K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
1,925 |
1,805 |
$97K |
| 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 |
1,050 |
930 |
$96K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
633 |
608 |
$81K |
| A4452 |
Tape, waterproof, per 18 square inches |
4,537 |
4,107 |
$80K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
525 |
476 |
$80K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
797 |
736 |
$78K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,441 |
1,310 |
$77K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
517 |
367 |
$76K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,236 |
4,872 |
$73K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,565 |
1,428 |
$66K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
1,500 |
1,395 |
$66K |
| 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 |
705 |
626 |
$60K |
| A5120 |
Skin barrier, wipes or swabs, each |
10,525 |
9,698 |
$50K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
781 |
714 |
$44K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,716 |
2,483 |
$44K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
5,102 |
4,735 |
$40K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
614 |
575 |
$40K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,712 |
5,233 |
$39K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
548 |
500 |
$36K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
1,015 |
908 |
$36K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
705 |
627 |
$35K |
| 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 |
1,231 |
1,111 |
$33K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
783 |
682 |
$31K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,037 |
956 |
$31K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,930 |
1,677 |
$27K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
869 |
816 |
$27K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,803 |
4,065 |
$26K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
683 |
619 |
$26K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
930 |
854 |
$25K |
| A4371 |
Ostomy skin barrier, powder, per oz |
5,743 |
5,345 |
$24K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,154 |
5,674 |
$23K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,583 |
3,296 |
$22K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
642 |
597 |
$17K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
961 |
893 |
$16K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
481 |
426 |
$16K |
| 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 |
618 |
565 |
$13K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
485 |
440 |
$12K |
| A4367 |
Ostomy belt, each |
4,201 |
3,889 |
$11K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,175 |
1,086 |
$11K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
413 |
381 |
$10K |
| A4217 |
Sterile water/saline, 500 ml |
1,633 |
1,505 |
$10K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
500 |
444 |
$9K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
114 |
105 |
$9K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,453 |
1,267 |
$9K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
204 |
182 |
$7K |
| A4402 |
Lubricant, per ounce |
1,986 |
1,816 |
$7K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
425 |
395 |
$6K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
664 |
614 |
$6K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
27 |
27 |
$6K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,443 |
1,342 |
$6K |
| A4392 |
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
84 |
77 |
$6K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
715 |
653 |
$6K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
617 |
552 |
$5K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
828 |
773 |
$5K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
1,443 |
1,359 |
$5K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
53 |
51 |
$4K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
496 |
452 |
$4K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
402 |
362 |
$3K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
157 |
144 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
432 |
398 |
$3K |
| A4396 |
Ostomy belt with peristomal hernia support |
266 |
243 |
$3K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
377 |
321 |
$3K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
987 |
854 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
523 |
458 |
$2K |
| A4930 |
Gloves, sterile, per pair |
116 |
101 |
$2K |
| 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 |
68 |
57 |
$2K |
| A4335 |
Incontinence supply; miscellaneous |
971 |
856 |
$2K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
13 |
13 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,324 |
2,151 |
$2K |
| A4670 |
Automatic blood pressure monitor |
54 |
54 |
$2K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,140 |
987 |
$1K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
111 |
84 |
$1K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
88 |
80 |
$1K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
42 |
39 |
$1K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
69 |
65 |
$1K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
105 |
97 |
$1K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
87 |
80 |
$1K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
218 |
187 |
$878.50 |
| 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 |
38 |
24 |
$735.13 |
| 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 |
26 |
25 |
$566.57 |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
58 |
53 |
$520.44 |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
12 |
12 |
$318.58 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
41 |
39 |
$256.17 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
31 |
30 |
$210.37 |
| 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 |
14 |
13 |
$154.82 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
16 |
15 |
$114.79 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
26 |
25 |
$30.71 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
15 |
12 |
$22.50 |