| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
3,415 |
3,121 |
$979K |
| A6021 |
Collagen dressing <=16 sq in |
2,337 |
2,228 |
$448K |
| A4385 |
Ost skn barrier sld ext wear |
6,858 |
6,644 |
$337K |
| A6212 |
Foam drg <=16 sq in w/border |
2,778 |
2,528 |
$303K |
| A4351 |
Straight tip urine catheter |
1,745 |
1,672 |
$225K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,097 |
991 |
$218K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,742 |
1,616 |
$214K |
| A6196 |
Alginate dressing <=16 sq in |
1,899 |
1,770 |
$206K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
3,688 |
3,485 |
$201K |
| E0603 |
Electric breast pump |
1,742 |
1,736 |
$192K |
| A4409 |
Ost skn barr convex <=4 sq i |
3,375 |
3,276 |
$191K |
| A4407 |
Ext wear ost skn barr <=4sq" |
2,689 |
2,575 |
$160K |
| A4362 |
Solid skin barrier |
3,767 |
3,694 |
$153K |
| A5057 |
1 pc ost pou w built-in conv |
1,226 |
1,186 |
$130K |
| A4253 |
Blood glucose/reagent strips |
2,462 |
2,402 |
$125K |
| A4425 |
Ost pch drain for barrier fl |
2,841 |
2,746 |
$119K |
| A4452 |
Waterproof tape |
5,110 |
4,907 |
$102K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,329 |
4,945 |
$101K |
| A4394 |
Ostomy pouch liq deodorant |
4,210 |
4,104 |
$94K |
| A9276 |
Disposable sensor, cgm sys |
280 |
273 |
$90K |
| A5063 |
Drain ostomy pouch w/flange |
2,739 |
2,655 |
$75K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
826 |
754 |
$62K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
795 |
769 |
$47K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
987 |
929 |
$43K |
| K0553 |
Ther cgm supply allowance |
509 |
503 |
$42K |
| A4239 |
Non-adju cgm supply allow |
552 |
530 |
$41K |
| A4456 |
Adhesive remover, wipes |
4,622 |
4,539 |
$34K |
| A5120 |
Skin barrier, wipe or swab |
6,726 |
6,549 |
$32K |
| A6402 |
Sterile gauze <= 16 sq in |
4,280 |
4,119 |
$31K |
| A5121 |
Solid skin barrier 6x6 |
456 |
446 |
$30K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,158 |
1,051 |
$30K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,359 |
4,154 |
$27K |
| A4406 |
Pectin based ostomy paste |
1,921 |
1,876 |
$26K |
| A4450 |
Non-waterproof tape |
3,789 |
3,672 |
$17K |
| A4352 |
Coude tip urinary catheter |
42 |
39 |
$16K |
| A5056 |
1 pc ost pouch w filter |
235 |
230 |
$16K |
| A4371 |
Skin barrier powder per oz |
3,630 |
3,551 |
$14K |
| A4259 |
Lancets per box |
1,969 |
1,930 |
$14K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
369 |
350 |
$13K |
| A4367 |
Ostomy belt |
2,808 |
2,762 |
$13K |
| A6454 |
Self-adher band w>=3" <5"/yd |
364 |
345 |
$12K |
| A4419 |
Ost pch for bar w flange/flt |
283 |
280 |
$11K |
| A4357 |
Bedside drainage bag |
1,209 |
1,164 |
$10K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
717 |
686 |
$7K |
| A6266 |
Impreg gauze no h20/sal/yard |
160 |
149 |
$7K |
| A6199 |
Alginate drsg wound filler |
86 |
77 |
$6K |
| A4927 |
Non-sterile gloves |
608 |
591 |
$6K |
| A4230 |
Infus insulin pump non needl |
41 |
39 |
$5K |
| A4389 |
Drainable pch w st wear barr |
56 |
54 |
$5K |
| A4432 |
Os pch urine w bar/fange/tap |
128 |
124 |
$4K |
| A4369 |
Skin barrier liquid per oz |
419 |
411 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
86 |
81 |
$1K |
| A6457 |
Tubular dressing |
161 |
154 |
$1K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
14 |
13 |
$1K |
| A6248 |
Hydrogel drsg gel filler |
39 |
38 |
$1K |
| A4232 |
Syringe w/needle insulin 3cc |
25 |
24 |
$877.31 |
| A4424 |
Ost pch drain w bar & filter |
14 |
14 |
$796.04 |
| A6240 |
Hydrocolld drg filler paste |
12 |
12 |
$483.88 |
| A4427 |
Ost pch drain/barr lk flng/f |
14 |
12 |
$435.18 |
| A4455 |
Adhesive remover per ounce |
52 |
48 |
$206.85 |
| A6260 |
Wound cleanser any type/size |
12 |
12 |
$39.91 |