| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
Ext amb infusn pump insulin |
25,604 |
24,723 |
$11.24M |
| A9276 |
Disposable sensor, cgm sys |
16,951 |
16,113 |
$6.36M |
| A4230 |
Infus insulin pump non needl |
42,484 |
39,709 |
$6.08M |
| K0553 |
Ther cgm supply allowance |
33,361 |
31,633 |
$5.81M |
| T4534 |
Youth size pull-on |
45,390 |
43,379 |
$3.44M |
| A4232 |
Syringe w/needle insulin 3cc |
44,836 |
42,653 |
$2.85M |
| A4239 |
Non-adju cgm supply allow |
15,681 |
14,537 |
$2.78M |
| A4385 |
Ost skn barrier sld ext wear |
32,005 |
29,240 |
$2.41M |
| A4351 |
Straight tip urine catheter |
16,238 |
14,467 |
$2.36M |
| A9277 |
External transmitter, cgm |
3,838 |
3,610 |
$2.25M |
| A6197 |
Alginate drsg >16 <=48 sq in |
5,926 |
5,124 |
$2.21M |
| T4541 |
Large disposable underpad |
75,675 |
71,434 |
$2.20M |
| T4527 |
Adult size pull-on lg |
29,694 |
27,938 |
$2.17M |
| T4526 |
Adult size pull-on med |
33,666 |
31,738 |
$2.12M |
| T4528 |
Adult size pull-on xl |
26,278 |
24,381 |
$1.92M |
| A4407 |
Ext wear ost skn barr <=4sq" |
16,169 |
14,633 |
$1.87M |
| A4409 |
Ost skn barr convex <=4 sq i |
20,641 |
18,662 |
$1.76M |
| T4535 |
Disposable liner/shield/pad |
57,320 |
53,796 |
$1.71M |
| A6212 |
Foam drg <=16 sq in w/border |
8,143 |
7,127 |
$1.39M |
| A4927 |
Non-sterile gloves |
141,253 |
129,702 |
$1.32M |
| T4537 |
Reusable underpad bed size |
44,767 |
42,434 |
$1.27M |
| A4224 |
Supply insulin inf cath/wk |
17,094 |
15,737 |
$1.23M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
3,217 |
2,793 |
$1.20M |
| E0603 |
Electric breast pump |
10,009 |
9,890 |
$1.19M |
| T4522 |
Adult size brief/diaper med |
17,381 |
16,521 |
$1.10M |
| A4352 |
Coude tip urinary catheter |
3,382 |
2,892 |
$1.10M |
| T4530 |
Ped size brief/diaper lg |
20,315 |
19,403 |
$1.06M |
| A4353 |
Intermittent urinary cath |
1,941 |
1,663 |
$1.02M |
| T4523 |
Adult size brief/diaper lg |
13,822 |
13,082 |
$1.01M |
| A4362 |
Solid skin barrier |
17,060 |
14,830 |
$738K |
| A9278 |
External receiver, cgm sys |
1,345 |
1,272 |
$665K |
| A4394 |
Ostomy pouch liq deodorant |
20,254 |
18,548 |
$661K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,844 |
2,363 |
$657K |
| A4425 |
Ost pch drain for barrier fl |
18,115 |
15,764 |
$641K |
| A9274 |
Ext amb insulin delivery sys |
1,251 |
1,196 |
$636K |
| T4524 |
Adult size brief/diaper xl |
6,763 |
6,304 |
$551K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
5,415 |
4,766 |
$521K |
| A4221 |
Supp non-insulin inf cath/wk |
7,742 |
6,833 |
$511K |
| A5057 |
1 pc ost pou w built-in conv |
4,190 |
3,789 |
$499K |
| A5063 |
Drain ostomy pouch w/flange |
13,460 |
11,932 |
$493K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,491 |
3,353 |
$488K |
| T4543 |
Adult disp brief/diap abv xl |
2,528 |
2,296 |
$453K |
| A6021 |
Collagen dressing <=16 sq in |
1,786 |
1,529 |
$450K |
| A4225 |
Sup/ext insulin inf pump syr |
16,411 |
15,444 |
$447K |
| T4525 |
Adult size pull-on sm |
6,174 |
5,822 |
$427K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,597 |
2,320 |
$396K |
| B4035 |
Enteral feed supp pump per d |
1,774 |
1,616 |
$385K |
| A4419 |
Ost pch for bar w flange/flt |
7,475 |
6,591 |
$381K |
| A6196 |
Alginate dressing <=16 sq in |
2,929 |
2,590 |
$379K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
5,412 |
4,685 |
$372K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,972 |
1,701 |
$321K |
| A5121 |
Solid skin barrier 6x6 |
3,769 |
3,418 |
$310K |
| B4161 |
Ef ped hydrolyzed/amino acid |
580 |
498 |
$298K |
| A4456 |
Adhesive remover, wipes |
33,593 |
30,968 |
$294K |
| K0554 |
Ther cgm receiver/monitor |
1,711 |
1,604 |
$279K |
| T4532 |
Ped size pull-on lg |
4,842 |
4,486 |
$278K |
| A4344 |
Cath indw foley 2 way silicn |
3,538 |
2,337 |
$269K |
| A6446 |
Conform band s w>=3" <5"/yd |
6,898 |
5,942 |
$251K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
2,857 |
2,574 |
$222K |
| B4150 |
Ef complet w/intact nutrient |
2,688 |
1,679 |
$217K |
| A4452 |
Waterproof tape |
11,091 |
9,900 |
$196K |
| A5056 |
1 pc ost pouch w filter |
2,727 |
2,492 |
$181K |
| B9998 |
Enteral supp not otherwise c |
2,017 |
1,694 |
$181K |
| A5054 |
Clsd ostomy pouch w/flange |
2,642 |
2,290 |
$178K |
| A5120 |
Skin barrier, wipe or swab |
35,133 |
31,437 |
$173K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,513 |
1,179 |
$172K |
| A4357 |
Bedside drainage bag |
17,132 |
15,157 |
$165K |
| A4406 |
Pectin based ostomy paste |
9,797 |
8,773 |
$157K |
| T4533 |
Youth size brief/diaper |
2,807 |
2,568 |
$153K |
| A4432 |
Os pch urine w bar/fange/tap |
5,008 |
4,308 |
$143K |
| A4322 |
Irrigation syringe |
4,703 |
4,137 |
$142K |
| T4521 |
Adult size brief/diaper sm |
2,831 |
2,697 |
$141K |
| A4390 |
Drainable pch ex wear convex |
1,822 |
1,614 |
$139K |
| A4424 |
Ost pch drain w bar & filter |
2,488 |
2,181 |
$131K |
| A4310 |
Insert tray w/o bag/cath |
4,144 |
3,724 |
$122K |
| A4373 |
Skin barrier with flange |
1,377 |
1,273 |
$122K |
| A4349 |
Disposable male external cat |
3,598 |
3,081 |
$115K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,705 |
1,480 |
$111K |
| A4231 |
Infusion insulin pump needle |
770 |
734 |
$108K |
| K0552 |
Sup/ext non-ins inf pump syr |
3,852 |
3,674 |
$108K |
| A4388 |
Drainable pch w ex wear barr |
2,369 |
2,140 |
$95K |
| A6258 |
Transparent film >16<=48 in |
1,059 |
945 |
$94K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,297 |
1,199 |
$86K |
| B4152 |
Ef calorie dense>/=1.5kcal |
909 |
665 |
$81K |
| E2103 |
Non-adju cgm receiver/mon |
579 |
541 |
$78K |
| A5061 |
Pouch drainable w barrier at |
1,713 |
1,485 |
$78K |
| A4389 |
Drainable pch w st wear barr |
1,320 |
1,174 |
$75K |
| A4416 |
Ost pch clsd w barrier/filtr |
1,303 |
1,170 |
$75K |
| A4338 |
Indwelling catheter latex |
3,893 |
3,172 |
$74K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,413 |
1,323 |
$71K |
| A4411 |
Ost skn barr extnd =4sq |
1,019 |
924 |
$67K |
| A4427 |
Ost pch drain/barr lk flng/f |
2,358 |
2,061 |
$61K |
| A4371 |
Skin barrier powder per oz |
15,219 |
14,051 |
$59K |
| A6216 |
Non-sterile gauze<=16 sq in |
6,851 |
6,302 |
$58K |
| A6402 |
Sterile gauze <= 16 sq in |
5,907 |
5,336 |
$57K |
| A4335 |
Incontinence supply |
7,077 |
6,584 |
$54K |
| B4036 |
Enteral feed sup kit grav by |
1,536 |
1,439 |
$53K |
| A4410 |
Ost skn barr extnd >4 sq |
507 |
437 |
$52K |
| A4358 |
Urinary leg or abdomen bag |
7,559 |
6,624 |
$50K |
| B4087 |
Gastro/jejuno tube, std |
469 |
419 |
$49K |
| A6199 |
Alginate drsg wound filler |
282 |
256 |
$44K |
| A4367 |
Ostomy belt |
10,566 |
9,644 |
$43K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
405 |
376 |
$42K |
| A4402 |
Lubricant per ounce |
6,607 |
6,170 |
$40K |
| A4396 |
Peristomal hernia supprt blt |
1,484 |
1,372 |
$38K |
| A4430 |
Ost urine pch w b/bltin conv |
718 |
619 |
$37K |
| A4253 |
Blood glucose/reagent strips |
1,308 |
1,092 |
$30K |
| A4217 |
Sterile water/saline, 500 ml |
1,862 |
1,696 |
$30K |
| A6257 |
Transparent film <= 16 sq in |
785 |
751 |
$28K |
| A4332 |
Lube sterile packet |
2,956 |
2,714 |
$23K |
| A6452 |
High compres band w>=3"<5"yd |
151 |
116 |
$22K |
| A4369 |
Skin barrier liquid per oz |
6,525 |
5,807 |
$21K |
| A6457 |
Tubular dressing |
1,242 |
1,118 |
$20K |
| B4034 |
Enter feed supkit syr by day |
218 |
205 |
$20K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
49 |
38 |
$20K |
| A4450 |
Non-waterproof tape |
4,584 |
4,217 |
$19K |
| A4333 |
Urinary cath anchor device |
2,376 |
2,113 |
$17K |
| A4320 |
Irrigation tray |
974 |
845 |
$17K |
| A6441 |
Pad band w>=3" <5"/yd |
484 |
424 |
$14K |
| A4520 |
Incontinence garment anytype |
429 |
354 |
$12K |
| A4554 |
Disposable underpads |
557 |
536 |
$12K |
| A4423 |
Ost pch for bar w lk fl/fltr |
223 |
201 |
$11K |
| A4366 |
Ostomy vent |
647 |
559 |
$9K |
| A6219 |
Gauze <= 16 sq in w/border |
387 |
362 |
$9K |
| A4413 |
2 pc drainable ost pouch |
202 |
184 |
$8K |
| A4649 |
Surgical supplies |
592 |
557 |
$8K |
| A5055 |
Stoma cap |
224 |
212 |
$8K |
| A4405 |
Nonpectin based ostomy paste |
670 |
617 |
$7K |
| A4334 |
Urinary cath leg strap |
2,011 |
1,867 |
$6K |
| A4455 |
Adhesive remover per ounce |
2,817 |
2,610 |
$6K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
213 |
192 |
$6K |
| A6266 |
Impreg gauze no h20/sal/yard |
77 |
68 |
$6K |
| B4154 |
Ef spec metabolic noninherit |
29 |
24 |
$5K |
| A4364 |
Adhesive, liquid or equal |
640 |
590 |
$5K |
| A4331 |
Extension drainage tubing |
1,431 |
1,319 |
$4K |
| A4363 |
Ostomy clamp, replacement |
1,064 |
855 |
$4K |
| A4314 |
Cath w/drainage 2-way latex |
407 |
383 |
$4K |
| A4245 |
Alcohol wipes per box |
2,368 |
2,161 |
$4K |
| A6260 |
Wound cleanser any type/size |
533 |
497 |
$3K |
| A4930 |
Sterile, gloves per pair |
270 |
248 |
$3K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
14 |
13 |
$2K |
| A4247 |
Betadine/iodine swabs/wipes |
777 |
697 |
$2K |
| A4340 |
Indwelling catheter special |
46 |
26 |
$2K |
| A4412 |
Ost pouch drain high output |
43 |
37 |
$2K |
| A6248 |
Hydrogel drsg gel filler |
32 |
26 |
$1K |
| A4259 |
Lancets per box |
268 |
219 |
$739.01 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
15 |
12 |
$701.93 |
| E1399 |
Durable medical equipment mi |
55 |
50 |
$692.32 |
| A4422 |
Ost pouch absorbent material |
36 |
36 |
$469.40 |
| A4354 |
Cath insertion tray w/bag |
27 |
26 |
$54.34 |
| A9270 |
Non-covered item or service |
57 |
50 |
$14.95 |