| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,541 |
927 |
$132K |
| A4554 |
Disposable underpads, all sizes |
2,153 |
1,431 |
$46K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,218 |
707 |
$41K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
673 |
410 |
$23K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
997 |
572 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
1,971 |
1,242 |
$11K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
65 |
48 |
$5K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
45 |
24 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
100 |
71 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
509 |
251 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,100 |
752 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
30 |
26 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
556 |
309 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
271 |
165 |
$903.15 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
18 |
13 |
$827.44 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
14 |
14 |
$712.20 |
| A5120 |
Skin barrier, wipes or swabs, each |
366 |
200 |
$673.24 |
| A4670 |
Automatic blood pressure monitor |
13 |
13 |
$572.94 |
| A4335 |
Incontinence supply; miscellaneous |
145 |
105 |
$485.65 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
48 |
26 |
$436.56 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
70 |
37 |
$380.31 |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
15 |
12 |
$204.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
36 |
27 |
$47.20 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
17 |
12 |
$17.04 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
377 |
304 |
$0.00 |
| T4541 |
Incontinence product, disposable underpad, large, each |
92 |
51 |
$0.00 |