| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
External ambulatory infusion pump, insulin |
25,604 |
24,723 |
$11.24M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
16,951 |
16,113 |
$6.36M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
42,484 |
39,709 |
$6.08M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
33,361 |
31,633 |
$5.81M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
45,390 |
43,379 |
$3.44M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
44,836 |
42,653 |
$2.85M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
15,681 |
14,537 |
$2.78M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
32,005 |
29,240 |
$2.41M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
16,238 |
14,467 |
$2.36M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
3,838 |
3,610 |
$2.25M |
| 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 |
5,926 |
5,124 |
$2.21M |
| T4541 |
Incontinence product, disposable underpad, large, each |
75,675 |
71,434 |
$2.20M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
29,694 |
27,938 |
$2.17M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
33,666 |
31,738 |
$2.12M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
26,278 |
24,381 |
$1.92M |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
16,169 |
14,633 |
$1.87M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
20,641 |
18,662 |
$1.76M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
57,320 |
53,796 |
$1.71M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
8,143 |
7,127 |
$1.39M |
| A4927 |
Gloves, non-sterile, per 100 |
141,253 |
129,702 |
$1.32M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
44,767 |
42,434 |
$1.27M |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
17,094 |
15,737 |
$1.23M |
| 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 |
3,217 |
2,793 |
$1.20M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
10,009 |
9,890 |
$1.19M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
17,381 |
16,521 |
$1.10M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
3,382 |
2,892 |
$1.10M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
20,315 |
19,403 |
$1.06M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,941 |
1,663 |
$1.02M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,822 |
13,082 |
$1.01M |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
17,060 |
14,830 |
$738K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
1,345 |
1,272 |
$665K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
20,254 |
18,548 |
$661K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,844 |
2,363 |
$657K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
18,115 |
15,764 |
$641K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
1,251 |
1,196 |
$636K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,763 |
6,304 |
$551K |
| 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 |
5,415 |
4,766 |
$521K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
7,742 |
6,833 |
$511K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
4,190 |
3,789 |
$499K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
13,460 |
11,932 |
$493K |
| 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 |
5,491 |
3,353 |
$488K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,528 |
2,296 |
$453K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,786 |
1,529 |
$450K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
16,411 |
15,444 |
$447K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,174 |
5,822 |
$427K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,597 |
2,320 |
$396K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,774 |
1,616 |
$385K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
7,475 |
6,591 |
$381K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
2,929 |
2,590 |
$379K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
5,412 |
4,685 |
$372K |
| 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 |
1,972 |
1,701 |
$321K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
3,769 |
3,418 |
$310K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
580 |
498 |
$298K |
| A4456 |
Adhesive remover, wipes, any type, each |
33,593 |
30,968 |
$294K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
1,711 |
1,604 |
$279K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,842 |
4,486 |
$278K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
3,538 |
2,337 |
$269K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
6,898 |
5,942 |
$251K |
| 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 |
2,857 |
2,574 |
$222K |
| 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 |
2,688 |
1,679 |
$217K |
| A4452 |
Tape, waterproof, per 18 square inches |
11,091 |
9,900 |
$196K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
2,727 |
2,492 |
$181K |
| B9998 |
Noc for enteral supplies |
2,017 |
1,694 |
$181K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
2,642 |
2,290 |
$178K |
| A5120 |
Skin barrier, wipes or swabs, each |
35,133 |
31,437 |
$173K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,513 |
1,179 |
$172K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
17,132 |
15,157 |
$165K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
9,797 |
8,773 |
$157K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,807 |
2,568 |
$153K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
5,008 |
4,308 |
$143K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,703 |
4,137 |
$142K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,831 |
2,697 |
$141K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
1,822 |
1,614 |
$139K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
2,488 |
2,181 |
$131K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
4,144 |
3,724 |
$122K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
1,377 |
1,273 |
$122K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
3,598 |
3,081 |
$115K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,705 |
1,480 |
$111K |
| A4231 |
Infusion set for external insulin pump, needle type |
770 |
734 |
$108K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
3,852 |
3,674 |
$108K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
2,369 |
2,140 |
$95K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,059 |
945 |
$94K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,297 |
1,199 |
$86K |
| 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 |
909 |
665 |
$81K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
579 |
541 |
$78K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,713 |
1,485 |
$78K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
1,320 |
1,174 |
$75K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
1,303 |
1,170 |
$75K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
3,893 |
3,172 |
$74K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,413 |
1,323 |
$71K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
1,019 |
924 |
$67K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
2,358 |
2,061 |
$61K |
| A4371 |
Ostomy skin barrier, powder, per oz |
15,219 |
14,051 |
$59K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,851 |
6,302 |
$58K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,907 |
5,336 |
$57K |
| A4335 |
Incontinence supply; miscellaneous |
7,077 |
6,584 |
$54K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,536 |
1,439 |
$53K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
507 |
437 |
$52K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
7,559 |
6,624 |
$50K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
469 |
419 |
$49K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
282 |
256 |
$44K |
| A4367 |
Ostomy belt, each |
10,566 |
9,644 |
$43K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
405 |
376 |
$42K |
| A4402 |
Lubricant, per ounce |
6,607 |
6,170 |
$40K |
| A4396 |
Ostomy belt with peristomal hernia support |
1,484 |
1,372 |
$38K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
718 |
619 |
$37K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,308 |
1,092 |
$30K |
| A4217 |
Sterile water/saline, 500 ml |
1,862 |
1,696 |
$30K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
785 |
751 |
$28K |
| A4332 |
Lubricant, individual sterile packet, each |
2,956 |
2,714 |
$23K |
| 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 |
151 |
116 |
$22K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
6,525 |
5,807 |
$21K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,242 |
1,118 |
$20K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
218 |
205 |
$20K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
49 |
38 |
$20K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
4,584 |
4,217 |
$19K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
2,376 |
2,113 |
$17K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
974 |
845 |
$17K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
484 |
424 |
$14K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
429 |
354 |
$12K |
| A4554 |
Disposable underpads, all sizes |
557 |
536 |
$12K |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
223 |
201 |
$11K |
| A4366 |
Ostomy vent, any type, each |
647 |
559 |
$9K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
387 |
362 |
$9K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
202 |
184 |
$8K |
| A4649 |
Surgical supply; miscellaneous |
592 |
557 |
$8K |
| A5055 |
Stoma cap |
224 |
212 |
$8K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
670 |
617 |
$7K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,011 |
1,867 |
$6K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
2,817 |
2,610 |
$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 |
213 |
192 |
$6K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
77 |
68 |
$6K |
| 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 |
29 |
24 |
$5K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
640 |
590 |
$5K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
1,431 |
1,319 |
$4K |
| A4363 |
Ostomy clamp, any type, replacement only, each |
1,064 |
855 |
$4K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
407 |
383 |
$4K |
| A4245 |
Alcohol wipes, per box |
2,368 |
2,161 |
$4K |
| A6260 |
Wound cleansers, any type, any size |
533 |
497 |
$3K |
| A4930 |
Gloves, sterile, per pair |
270 |
248 |
$3K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
14 |
13 |
$2K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
777 |
697 |
$2K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
46 |
26 |
$2K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
43 |
37 |
$2K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
32 |
26 |
$1K |
| A4259 |
Lancets, per box of 100 |
268 |
219 |
$739.01 |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
12 |
$701.93 |
| E1399 |
Durable medical equipment, miscellaneous |
55 |
50 |
$692.32 |
| A4422 |
Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each |
36 |
36 |
$469.40 |
| A4354 |
Insertion tray with drainage bag but without catheter |
27 |
26 |
$54.34 |
| A9270 |
Non-covered item or service |
57 |
50 |
$14.95 |