| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,250 |
1,894 |
$525K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
254 |
125 |
$203K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,362 |
1,181 |
$198K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,279 |
1,065 |
$173K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
344 |
297 |
$136K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,912 |
2,467 |
$121K |
| 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 |
453 |
359 |
$90K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,055 |
819 |
$81K |
| A4927 |
Gloves, non-sterile, per 100 |
3,599 |
3,031 |
$65K |
| A6154 |
Wound pouch, each |
383 |
295 |
$64K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,806 |
1,325 |
$54K |
| A6260 |
Wound cleansers, any type, any size |
838 |
690 |
$45K |
| 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 |
207 |
181 |
$43K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
156 |
133 |
$42K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
239 |
205 |
$38K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
106 |
77 |
$37K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,348 |
1,103 |
$34K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
607 |
467 |
$30K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
646 |
518 |
$20K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
26 |
24 |
$9K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
49 |
45 |
$7K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
29 |
28 |
$7K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
48 |
36 |
$6K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
27 |
26 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
14 |
12 |
$2K |
| L0630 |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
18 |
17 |
$2K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
38 |
36 |
$1K |
| A4456 |
Adhesive remover, wipes, any type, each |
78 |
74 |
$786.07 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
18 |
13 |
$241.52 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
18 |
12 |
$191.38 |