| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,963 |
3,748 |
$239K |
| A4927 |
Gloves, non-sterile, per 100 |
6,996 |
6,381 |
$196K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,191 |
1,123 |
$139K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,915 |
1,772 |
$100K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
614 |
566 |
$58K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,882 |
1,721 |
$50K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,837 |
2,750 |
$17K |
| A4245 |
Alcohol wipes, per box |
2,104 |
1,869 |
$13K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
142 |
127 |
$11K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,746 |
1,953 |
$10K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
3,268 |
2,353 |
$10K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,222 |
2,359 |
$9K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,193 |
1,937 |
$9K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
463 |
361 |
$5K |
| 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 |
43 |
38 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
980 |
615 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
829 |
508 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
389 |
355 |
$2K |
| A4402 |
Lubricant, per ounce |
1,529 |
1,070 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
12 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
525 |
372 |
$2K |
| A5114 |
Leg strap; foam or fabric, replacement only, per set |
332 |
274 |
$2K |
| A4553 |
Non-disposable underpads, all sizes |
65 |
64 |
$2K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
600 |
431 |
$661.58 |
| A4456 |
Adhesive remover, wipes, any type, each |
13 |
12 |
$131.35 |
| A6260 |
Wound cleansers, any type, any size |
18 |
12 |
$120.48 |