| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6211 |
Foam drg > 48 sq in w/o brdr |
7,131 |
5,107 |
$9.14M |
| A9276 |
Disposable sensor, cgm sys |
27,409 |
21,682 |
$6.74M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
9,840 |
7,103 |
$6.15M |
| A4554 |
Disposable underpads |
81,670 |
79,538 |
$4.67M |
| E0603 |
Electric breast pump |
37,629 |
34,026 |
$4.55M |
| A4239 |
Non-adju cgm supply allow |
43,936 |
37,858 |
$4.39M |
| K0553 |
Ther cgm supply allowance |
38,820 |
30,928 |
$3.54M |
| T4523 |
Adult size brief/diaper lg |
44,445 |
42,854 |
$3.43M |
| A6212 |
Foam drg <=16 sq in w/border |
30,515 |
22,500 |
$3.37M |
| T4522 |
Adult size brief/diaper med |
43,783 |
41,950 |
$2.52M |
| A9277 |
External transmitter, cgm |
6,720 |
5,349 |
$2.26M |
| T4524 |
Adult size brief/diaper xl |
25,831 |
24,901 |
$2.18M |
| A4351 |
Straight tip urine catheter |
29,147 |
22,137 |
$2.16M |
| A6197 |
Alginate drsg >16 <=48 sq in |
21,072 |
15,671 |
$2.14M |
| A4353 |
Intermittent urinary cath |
7,279 |
5,278 |
$2.12M |
| A4409 |
Ost skn barr convex <=4 sq i |
35,080 |
27,756 |
$1.46M |
| T4535 |
Disposable liner/shield/pad |
59,979 |
57,880 |
$1.39M |
| T4543 |
Adult disp brief/diap abv xl |
6,740 |
6,529 |
$1.12M |
| E0784 |
Ext amb infusn pump insulin |
1,500 |
1,063 |
$1.11M |
| A4385 |
Ost skn barrier sld ext wear |
32,777 |
25,835 |
$1.08M |
| A6207 |
Contact layer >16<= 48 sq in |
4,160 |
3,066 |
$1.06M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
29,360 |
23,331 |
$1.02M |
| A9274 |
Ext amb insulin delivery sys |
4,014 |
3,175 |
$1.01M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
11,240 |
8,861 |
$946K |
| A4407 |
Ext wear ost skn barr <=4sq" |
17,198 |
13,705 |
$865K |
| A6021 |
Collagen dressing <=16 sq in |
9,076 |
7,160 |
$838K |
| A6446 |
Conform band s w>=3" <5"/yd |
46,533 |
36,199 |
$813K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
8,917 |
6,756 |
$763K |
| A4352 |
Coude tip urinary catheter |
4,122 |
3,096 |
$746K |
| A4425 |
Ost pch drain for barrier fl |
29,342 |
23,010 |
$739K |
| A6196 |
Alginate dressing <=16 sq in |
12,672 |
9,945 |
$699K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
21,285 |
16,970 |
$661K |
| A9278 |
External receiver, cgm sys |
2,394 |
1,945 |
$656K |
| A4927 |
Non-sterile gloves |
120,082 |
111,874 |
$573K |
| A6402 |
Sterile gauze <= 16 sq in |
75,276 |
58,968 |
$569K |
| A4230 |
Infus insulin pump non needl |
5,817 |
4,447 |
$545K |
| A6449 |
Lt compres band >=3" <5"/yd |
8,488 |
6,449 |
$516K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
5,518 |
4,154 |
$501K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
9,493 |
7,391 |
$492K |
| A5063 |
Drain ostomy pouch w/flange |
26,343 |
21,194 |
$480K |
| T4527 |
Adult size pull-on lg |
8,165 |
6,928 |
$474K |
| A4452 |
Waterproof tape |
40,741 |
31,690 |
$440K |
| A4362 |
Solid skin barrier |
20,010 |
15,998 |
$435K |
| T4541 |
Large disposable underpad |
17,531 |
15,161 |
$433K |
| K0554 |
Ther cgm receiver/monitor |
4,490 |
3,378 |
$403K |
| T4526 |
Adult size pull-on med |
6,949 |
5,932 |
$360K |
| A6457 |
Tubular dressing |
8,614 |
5,879 |
$335K |
| T4528 |
Adult size pull-on xl |
4,959 |
4,113 |
$326K |
| E2103 |
Non-adju cgm receiver/mon |
3,774 |
3,118 |
$306K |
| A4424 |
Ost pch drain w bar & filter |
8,359 |
6,359 |
$290K |
| T4540 |
Reusable underpad chair size |
19,275 |
19,002 |
$260K |
| A5121 |
Solid skin barrier 6x6 |
6,411 |
5,131 |
$256K |
| T4534 |
Youth size pull-on |
3,825 |
3,482 |
$255K |
| T4521 |
Adult size brief/diaper sm |
5,211 |
4,940 |
$248K |
| A4394 |
Ostomy pouch liq deodorant |
22,357 |
17,709 |
$232K |
| A4432 |
Os pch urine w bar/fange/tap |
9,887 |
7,684 |
$231K |
| A4419 |
Ost pch for bar w flange/flt |
8,520 |
6,774 |
$230K |
| A4373 |
Skin barrier with flange |
4,813 |
3,966 |
$230K |
| A5120 |
Skin barrier, wipe or swab |
56,191 |
44,588 |
$228K |
| A6266 |
Impreg gauze no h20/sal/yard |
4,363 |
3,516 |
$226K |
| A4406 |
Pectin based ostomy paste |
26,830 |
20,850 |
$221K |
| A4520 |
Incontinence garment anytype |
4,733 |
3,917 |
$221K |
| A4357 |
Bedside drainage bag |
59,377 |
46,514 |
$221K |
| A4456 |
Adhesive remover, wipes |
36,257 |
28,926 |
$220K |
| A5057 |
1 pc ost pou w built-in conv |
2,868 |
2,330 |
$206K |
| A4389 |
Drainable pch w st wear barr |
4,360 |
3,416 |
$183K |
| A4450 |
Non-waterproof tape |
30,724 |
24,547 |
$183K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
8,629 |
6,785 |
$177K |
| A5061 |
Pouch drainable w barrier at |
6,963 |
5,830 |
$173K |
| A4349 |
Disposable male external cat |
8,573 |
6,551 |
$165K |
| A4216 |
Sterile water/saline, 10 ml |
19,416 |
15,723 |
$163K |
| A4314 |
Cath w/drainage 2-way latex |
30,738 |
23,954 |
$159K |
| A6219 |
Gauze <= 16 sq in w/border |
13,032 |
10,065 |
$146K |
| A6452 |
High compres band w>=3"<5"yd |
3,203 |
2,063 |
$143K |
| T4525 |
Adult size pull-on sm |
2,266 |
2,006 |
$138K |
| A4335 |
Incontinence supply |
3,790 |
3,156 |
$137K |
| A4232 |
Syringe w/needle insulin 3cc |
4,368 |
3,964 |
$130K |
| A6199 |
Alginate drsg wound filler |
3,219 |
2,551 |
$129K |
| A6445 |
Conform band s w <3"/yd |
3,953 |
3,143 |
$120K |
| A4388 |
Drainable pch w ex wear barr |
4,540 |
3,318 |
$119K |
| A4623 |
Tracheostomy inner cannula |
5,218 |
4,086 |
$119K |
| A6022 |
Collagen drsg>16<=48 sq in |
743 |
615 |
$116K |
| A4253 |
Blood glucose/reagent strips |
4,925 |
3,705 |
$107K |
| A4390 |
Drainable pch ex wear convex |
2,182 |
1,707 |
$104K |
| E0114 |
Crutch underarm pair no wood |
5,875 |
5,591 |
$102K |
| A5056 |
1 pc ost pouch w filter |
2,989 |
2,399 |
$101K |
| A4427 |
Ost pch drain/barr lk flng/f |
3,822 |
3,164 |
$98K |
| L4361 |
Pneuma/vac walk boot pre ots |
1,227 |
1,056 |
$95K |
| A6216 |
Non-sterile gauze<=16 sq in |
13,181 |
10,610 |
$94K |
| A4358 |
Urinary leg or abdomen bag |
22,127 |
16,983 |
$92K |
| T4530 |
Ped size brief/diaper lg |
1,901 |
1,673 |
$91K |
| L3809 |
Whfo w/o joints pre ots |
1,168 |
966 |
$90K |
| A4430 |
Ost urine pch w b/bltin conv |
2,436 |
1,858 |
$85K |
| A4371 |
Skin barrier powder per oz |
23,560 |
18,926 |
$84K |
| L4350 |
Ankle control ortho pre ots |
1,936 |
1,843 |
$82K |
| A4416 |
Ost pch clsd w barrier/filtr |
2,210 |
1,626 |
$81K |
| A6454 |
Self-adher band w>=3" <5"/yd |
8,635 |
6,263 |
$73K |
| A4217 |
Sterile water/saline, 500 ml |
8,829 |
7,114 |
$73K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
2,052 |
1,548 |
$73K |
| A5054 |
Clsd ostomy pouch w/flange |
2,847 |
2,323 |
$71K |
| L3908 |
Who cock-up nonmolde pre ots |
2,365 |
2,113 |
$70K |
| A6248 |
Hydrogel drsg gel filler |
2,404 |
1,952 |
$66K |
| A6260 |
Wound cleanser any type/size |
6,659 |
5,529 |
$64K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
4,682 |
3,804 |
$64K |
| A4428 |
Urine ost pouch w faucet/tap |
1,526 |
1,242 |
$64K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,579 |
1,922 |
$64K |
| A4410 |
Ost skn barr extnd >4 sq |
1,360 |
1,051 |
$64K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
4,405 |
2,981 |
$63K |
| A4629 |
Tracheostomy care kit |
4,847 |
3,867 |
$59K |
| L1830 |
Ko immob canvas long pre ots |
1,528 |
1,440 |
$58K |
| T4537 |
Reusable underpad bed size |
734 |
672 |
$57K |
| A6258 |
Transparent film >16<=48 in |
2,341 |
1,887 |
$57K |
| L3675 |
So vest canvas/web pre ots |
712 |
640 |
$50K |
| A6198 |
Alginate dressing > 48 sq in |
217 |
172 |
$49K |
| A6203 |
Composite drsg <= 16 sq in |
1,777 |
1,364 |
$48K |
| A4367 |
Ostomy belt |
11,170 |
9,088 |
$46K |
| A4344 |
Cath indw foley 2 way silicn |
3,066 |
2,276 |
$46K |
| A4315 |
Cath w/drainage 2-way silcne |
4,252 |
3,288 |
$41K |
| A4412 |
Ost pouch drain high output |
1,458 |
1,149 |
$41K |
| L4360 |
Pneumat walking boot pre cst |
409 |
357 |
$40K |
| K0552 |
Sup/ext non-ins inf pump syr |
1,484 |
596 |
$39K |
| A4415 |
Ost skn barr w/o conv >4 sqi |
1,602 |
1,315 |
$39K |
| A9999 |
Dme supply or accessory, nos |
2,300 |
1,998 |
$38K |
| A4322 |
Irrigation syringe |
3,904 |
2,876 |
$37K |
| A4402 |
Lubricant per ounce |
8,629 |
6,760 |
$36K |
| A4332 |
Lube sterile packet |
5,693 |
4,315 |
$33K |
| A4338 |
Indwelling catheter latex |
8,293 |
6,338 |
$31K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
1,987 |
1,582 |
$30K |
| A4354 |
Cath insertion tray w/bag |
2,223 |
1,718 |
$30K |
| A6240 |
Hydrocolld drg filler paste |
1,575 |
1,346 |
$29K |
| T4544 |
Adlt disp und/pull on abv xl |
289 |
242 |
$29K |
| A4413 |
2 pc drainable ost pouch |
679 |
503 |
$28K |
| A4333 |
Urinary cath anchor device |
12,939 |
9,951 |
$25K |
| L3674 |
So airplane w/wo joint cf |
361 |
266 |
$23K |
| L3808 |
Whfo, rigid w/o joints |
242 |
203 |
$23K |
| A4231 |
Infusion insulin pump needle |
412 |
379 |
$23K |
| A4392 |
Urinary pouch w st wear barr |
412 |
358 |
$21K |
| A6450 |
Lt compres band >=5"/yd |
1,206 |
1,006 |
$21K |
| L3660 |
So 8 ab rstr can/web pre ots |
2,359 |
1,715 |
$20K |
| A7526 |
Tracheostomy tube collar |
4,305 |
3,455 |
$19K |
| A6441 |
Pad band w>=3" <5"/yd |
4,071 |
2,870 |
$19K |
| T4533 |
Youth size brief/diaper |
435 |
414 |
$19K |
| A4320 |
Irrigation tray |
1,829 |
1,465 |
$18K |
| A6447 |
Conform band s w >=5"/yd |
357 |
299 |
$18K |
| A4411 |
Ost skn barr extnd =4sq |
824 |
600 |
$18K |
| L3670 |
So acro/clav can web pre ots |
376 |
317 |
$17K |
| A4215 |
Sterile needle |
878 |
721 |
$17K |
| L3257 |
Orth foot add charge split s |
850 |
825 |
$17K |
| A4423 |
Ost pch for bar w lk fl/fltr |
317 |
255 |
$17K |
| A4245 |
Alcohol wipes per box |
2,168 |
1,932 |
$16K |
| A4455 |
Adhesive remover per ounce |
4,569 |
3,685 |
$16K |
| A7030 |
Cpap full face mask |
213 |
196 |
$15K |
| A4311 |
Catheter w/o bag 2-way latex |
3,647 |
2,797 |
$15K |
| A4405 |
Nonpectin based ostomy paste |
3,090 |
2,538 |
$15K |
| A4310 |
Insert tray w/o bag/cath |
4,535 |
3,539 |
$13K |
| A4649 |
Surgical supplies |
437 |
313 |
$13K |
| A4369 |
Skin barrier liquid per oz |
4,169 |
3,320 |
$13K |
| A4259 |
Lancets per box |
3,455 |
2,680 |
$13K |
| A6407 |
Packing strips, non-impreg |
1,053 |
849 |
$13K |
| A4225 |
Sup/ext insulin inf pump syr |
788 |
634 |
$13K |
| L3260 |
Ambulatory surgical boot eac |
1,260 |
1,087 |
$11K |
| A4670 |
Automatic bp monitor, dial |
275 |
249 |
$10K |
| A4224 |
Supply insulin inf cath/wk |
322 |
274 |
$9K |
| L1820 |
Ko elas w/ condyle pads & jo |
148 |
138 |
$9K |
| L1812 |
Ko elastic w/joints pre ots |
197 |
193 |
$9K |
| A4247 |
Betadine/iodine swabs/wipes |
473 |
384 |
$9K |
| B4036 |
Enteral feed sup kit grav by |
486 |
407 |
$8K |
| T4532 |
Ped size pull-on lg |
98 |
93 |
$8K |
| A7031 |
Replacement facemask interfa |
237 |
216 |
$7K |
| A5071 |
Urinary pouch w/barrier |
161 |
98 |
$7K |
| A4364 |
Adhesive, liquid or equal |
1,997 |
1,538 |
$6K |
| A6250 |
Skin seal protect moisturizr |
298 |
238 |
$6K |
| A4334 |
Urinary cath leg strap |
3,940 |
2,967 |
$6K |
| A6257 |
Transparent film <= 16 sq in |
414 |
223 |
$5K |
| A4624 |
Tracheal suction tube |
153 |
113 |
$5K |
| A6154 |
Wound pouch each |
69 |
51 |
$5K |
| A7520 |
Trach/laryn tube non-cuffed |
470 |
343 |
$4K |
| A4312 |
Cath w/o bag 2-way silicone |
758 |
558 |
$4K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
66 |
55 |
$4K |
| A7034 |
Nasal application device |
87 |
81 |
$4K |
| A7037 |
Pos airway pressure tubing |
201 |
190 |
$3K |
| A7035 |
Pos airway press headgear |
155 |
143 |
$3K |
| A4340 |
Indwelling catheter special |
421 |
331 |
$2K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
134 |
94 |
$2K |
| A4604 |
Tubing with heating element |
85 |
73 |
$2K |
| A9900 |
Supply/accessory/service |
437 |
437 |
$2K |
| A4256 |
Calibrator solution/chips |
728 |
570 |
$2K |
| A4565 |
Slings |
394 |
375 |
$2K |
| A7032 |
Replacement nasal cushion |
53 |
47 |
$1K |
| A7038 |
Pos airway pressure filter |
454 |
385 |
$1K |
| A4331 |
Extension drainage tubing |
928 |
722 |
$1K |
| A4417 |
Ost pch w bar/bltinconv/fltr |
41 |
24 |
$894.12 |
| A6453 |
Self-adher band w <3"/yd |
81 |
66 |
$803.15 |
| A4399 |
Ostomy irrig cone/cath w brs |
138 |
102 |
$768.15 |
| A4398 |
Ostomy irrigation bag |
106 |
76 |
$747.49 |
| A4258 |
Lancet device each |
464 |
349 |
$730.74 |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
48 |
39 |
$714.24 |
| E0607 |
Blood glucose monitor home |
22 |
18 |
$600.00 |
| A7521 |
Trach/laryn tube cuffed |
217 |
154 |
$581.07 |
| A6214 |
Foam drg > 48 sq in w/border |
21 |
16 |
$576.59 |
| A4570 |
Splint |
92 |
91 |
$486.30 |
| A4393 |
Urine pch w ex wear bar conv |
15 |
13 |
$423.18 |
| A6231 |
Hydrogel dsg<=16 sq in |
31 |
24 |
$401.22 |
| A4433 |
Urine ost pch bar w lock fln |
17 |
12 |
$384.05 |
| E0602 |
Manual breast pump |
12 |
12 |
$344.22 |
| A4396 |
Peristomal hernia supprt blt |
18 |
12 |
$338.15 |
| A5114 |
Foam/fabric leg strap |
205 |
150 |
$287.43 |
| A4246 |
Betadine/phisohex solution |
30 |
26 |
$235.39 |
| A7039 |
Filter, non disposable w pap |
32 |
28 |
$210.28 |
| A4213 |
20+ cc syringe only |
17 |
14 |
$91.50 |
| A7046 |
Repl water chamber, pap dev |
127 |
117 |
$60.07 |
| A4363 |
Ostomy clamp, replacement |
15 |
12 |
$55.05 |