| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,415 |
3,121 |
$979K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,337 |
2,228 |
$448K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
6,858 |
6,644 |
$337K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,778 |
2,528 |
$303K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,745 |
1,672 |
$225K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,097 |
991 |
$218K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,742 |
1,616 |
$214K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,899 |
1,770 |
$206K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
3,688 |
3,485 |
$201K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,742 |
1,736 |
$192K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,375 |
3,276 |
$191K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,689 |
2,575 |
$160K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
3,767 |
3,694 |
$153K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,226 |
1,186 |
$130K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,462 |
2,402 |
$125K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,841 |
2,746 |
$119K |
| A4452 |
Tape, waterproof, per 18 square inches |
5,110 |
4,907 |
$102K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
5,329 |
4,945 |
$101K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
4,210 |
4,104 |
$94K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
280 |
273 |
$90K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,739 |
2,655 |
$75K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
826 |
754 |
$62K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
795 |
769 |
$47K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
987 |
929 |
$43K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
509 |
503 |
$42K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
552 |
530 |
$41K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,622 |
4,539 |
$34K |
| A5120 |
Skin barrier, wipes or swabs, each |
6,726 |
6,549 |
$32K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,280 |
4,119 |
$31K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
456 |
446 |
$30K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,158 |
1,051 |
$30K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,359 |
4,154 |
$27K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,921 |
1,876 |
$26K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,789 |
3,672 |
$17K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
42 |
39 |
$16K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
235 |
230 |
$16K |
| A4371 |
Ostomy skin barrier, powder, per oz |
3,630 |
3,551 |
$14K |
| A4259 |
Lancets, per box of 100 |
1,969 |
1,930 |
$14K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
369 |
350 |
$13K |
| A4367 |
Ostomy belt, each |
2,808 |
2,762 |
$13K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
364 |
345 |
$12K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
283 |
280 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,209 |
1,164 |
$10K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
717 |
686 |
$7K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
160 |
149 |
$7K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
86 |
77 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
608 |
591 |
$6K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
41 |
39 |
$5K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
56 |
54 |
$5K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
128 |
124 |
$4K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
419 |
411 |
$2K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
86 |
81 |
$1K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
161 |
154 |
$1K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
14 |
13 |
$1K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
39 |
38 |
$1K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
25 |
24 |
$877.31 |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
14 |
14 |
$796.04 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
12 |
12 |
$483.88 |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
14 |
12 |
$435.18 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
52 |
48 |
$206.85 |
| A6260 |
Wound cleansers, any type, any size |
12 |
12 |
$39.91 |