| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
13,447 |
13,112 |
$1.35M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
12,530 |
11,317 |
$770K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
2,653 |
2,620 |
$470K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
570 |
555 |
$294K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,919 |
1,849 |
$242K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
926 |
897 |
$94K |
| 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 |
307 |
270 |
$94K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
906 |
865 |
$94K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
1,155 |
1,093 |
$87K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
799 |
776 |
$71K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
145 |
142 |
$64K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,442 |
1,402 |
$63K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
568 |
558 |
$58K |
| 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 |
239 |
223 |
$50K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,916 |
1,840 |
$36K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
374 |
342 |
$23K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
249 |
224 |
$22K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
540 |
527 |
$19K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
108 |
104 |
$12K |
| A4927 |
Gloves, non-sterile, per 100 |
586 |
564 |
$9K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
57 |
54 |
$7K |
| 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 |
51 |
51 |
$5K |
| A4670 |
Automatic blood pressure monitor |
74 |
74 |
$4K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
40 |
40 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
468 |
437 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
12 |
12 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
25 |
25 |
$3K |
| E0570 |
Nebulizer, with compressor |
34 |
33 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
398 |
381 |
$2K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
15 |
14 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
40 |
36 |
$1K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
12 |
12 |
$1K |
| A4456 |
Adhesive remover, wipes, any type, each |
243 |
231 |
$938.09 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
37 |
37 |
$709.55 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$570.65 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
27 |
25 |
$553.43 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
13 |
13 |
$363.50 |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
12 |
12 |
$234.82 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
14 |
14 |
$117.30 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
53 |
53 |
$89.72 |
| A4371 |
Ostomy skin barrier, powder, per oz |
24 |
24 |
$78.21 |
| A4335 |
Incontinence supply; miscellaneous |
280 |
275 |
$60.17 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
13 |
13 |
$57.68 |