| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
31 |
27 |
$1K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
33 |
25 |
$1K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$995.08 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
81 |
64 |
$939.98 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
16 |
12 |
$644.36 |
| A5120 |
Skin barrier, wipes or swabs, each |
77 |
59 |
$462.60 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
16 |
13 |
$130.31 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
12 |
$69.95 |