| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
172,965 |
170,950 |
$9.04M |
| T4523 |
Adult size brief/diaper lg |
83,901 |
82,807 |
$6.80M |
| A9276 |
Disposable sensor, cgm sys |
24,532 |
20,649 |
$6.36M |
| K0553 |
Ther cgm supply allowance |
31,820 |
30,411 |
$6.00M |
| T4535 |
Disposable liner/shield/pad |
173,902 |
169,267 |
$5.11M |
| T4524 |
Adult size brief/diaper xl |
54,431 |
53,680 |
$4.53M |
| T4522 |
Adult size brief/diaper med |
72,253 |
71,190 |
$4.36M |
| E0784 |
Ext amb infusn pump insulin |
2,604 |
2,296 |
$3.77M |
| A4351 |
Straight tip urine catheter |
17,266 |
16,011 |
$2.97M |
| A4353 |
Intermittent urinary cath |
6,691 |
6,053 |
$2.96M |
| A4239 |
Non-adju cgm supply allow |
14,014 |
12,937 |
$2.62M |
| T4526 |
Adult size pull-on med |
41,912 |
39,982 |
$2.60M |
| A6197 |
Alginate drsg >16 <=48 sq in |
15,379 |
14,201 |
$2.52M |
| T4527 |
Adult size pull-on lg |
32,514 |
31,038 |
$2.20M |
| T4543 |
Adult disp brief/diap abv xl |
13,039 |
12,863 |
$2.04M |
| A4230 |
Infus insulin pump non needl |
16,673 |
15,179 |
$1.80M |
| A9277 |
External transmitter, cgm |
4,814 |
4,280 |
$1.70M |
| B4150 |
Ef complet w/intact nutrient |
31,081 |
21,516 |
$1.69M |
| T4537 |
Reusable underpad bed size |
47,233 |
46,537 |
$1.56M |
| A4385 |
Ost skn barrier sld ext wear |
23,675 |
22,027 |
$1.46M |
| A6212 |
Foam drg <=16 sq in w/border |
17,929 |
16,219 |
$1.45M |
| T4528 |
Adult size pull-on xl |
20,335 |
19,104 |
$1.40M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
18,150 |
17,109 |
$1.05M |
| A4927 |
Non-sterile gloves |
189,754 |
186,159 |
$1.04M |
| A4253 |
Blood glucose/reagent strips |
43,592 |
41,347 |
$965K |
| T4541 |
Large disposable underpad |
35,820 |
33,471 |
$944K |
| A4409 |
Ost skn barr convex <=4 sq i |
15,121 |
14,118 |
$939K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
5,763 |
5,130 |
$933K |
| A4407 |
Ext wear ost skn barr <=4sq" |
10,931 |
10,162 |
$895K |
| A4425 |
Ost pch drain for barrier fl |
14,300 |
13,608 |
$797K |
| A4352 |
Coude tip urinary catheter |
1,891 |
1,731 |
$760K |
| A6021 |
Collagen dressing <=16 sq in |
5,600 |
5,094 |
$749K |
| B4154 |
Ef spec metabolic noninherit |
19,570 |
13,998 |
$736K |
| E0603 |
Electric breast pump |
5,808 |
5,600 |
$716K |
| A6196 |
Alginate dressing <=16 sq in |
7,301 |
6,499 |
$709K |
| A4362 |
Solid skin barrier |
14,504 |
13,664 |
$694K |
| A9274 |
Ext amb insulin delivery sys |
1,862 |
1,678 |
$657K |
| T4534 |
Youth size pull-on |
6,807 |
6,362 |
$637K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
9,676 |
9,086 |
$627K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
5,497 |
5,180 |
$606K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
4,731 |
4,286 |
$587K |
| A5063 |
Drain ostomy pouch w/flange |
11,345 |
10,475 |
$493K |
| T4530 |
Ped size brief/diaper lg |
7,578 |
7,326 |
$490K |
| A4224 |
Supply insulin inf cath/wk |
7,164 |
6,669 |
$471K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
889 |
770 |
$446K |
| T4521 |
Adult size brief/diaper sm |
8,010 |
7,870 |
$442K |
| A5057 |
1 pc ost pou w built-in conv |
2,819 |
2,654 |
$433K |
| A4357 |
Bedside drainage bag |
18,399 |
16,965 |
$390K |
| A6449 |
Lt compres band >=3" <5"/yd |
10,044 |
9,209 |
$384K |
| A4344 |
Cath indw foley 2 way silicn |
2,314 |
2,121 |
$366K |
| A6402 |
Sterile gauze <= 16 sq in |
31,714 |
30,052 |
$345K |
| A6446 |
Conform band s w>=3" <5"/yd |
17,775 |
16,587 |
$341K |
| A4335 |
Incontinence supply |
66,596 |
51,924 |
$340K |
| T4533 |
Youth size brief/diaper |
5,930 |
5,855 |
$338K |
| A4419 |
Ost pch for bar w flange/flt |
5,094 |
4,716 |
$333K |
| A4349 |
Disposable male external cat |
6,939 |
6,253 |
$325K |
| B4152 |
Ef calorie dense>/=1.5kcal |
7,803 |
5,655 |
$324K |
| A4232 |
Syringe w/needle insulin 3cc |
10,155 |
9,326 |
$309K |
| T5999 |
Supply, nos |
462 |
409 |
$305K |
| A9278 |
External receiver, cgm sys |
876 |
768 |
$295K |
| B4161 |
Ef ped hydrolyzed/amino acid |
577 |
517 |
$293K |
| A4394 |
Ostomy pouch liq deodorant |
14,168 |
13,353 |
$287K |
| A6199 |
Alginate drsg wound filler |
3,019 |
2,645 |
$260K |
| A4670 |
Automatic bp monitor, dial |
4,316 |
4,270 |
$260K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
4,698 |
4,229 |
$253K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
5,385 |
5,049 |
$236K |
| K0552 |
Sup/ext non-ins inf pump syr |
6,201 |
5,886 |
$236K |
| A5121 |
Solid skin barrier 6x6 |
2,997 |
2,797 |
$236K |
| A4358 |
Urinary leg or abdomen bag |
11,136 |
10,286 |
$234K |
| K0554 |
Ther cgm receiver/monitor |
1,682 |
1,480 |
$228K |
| A4452 |
Waterproof tape |
20,329 |
19,136 |
$227K |
| T4525 |
Adult size pull-on sm |
3,796 |
3,656 |
$227K |
| A5120 |
Skin barrier, wipe or swab |
29,930 |
28,189 |
$210K |
| A4453 |
Rec cath any transanal, each |
511 |
504 |
$200K |
| A4456 |
Adhesive remover, wipes |
23,287 |
22,004 |
$196K |
| A4225 |
Sup/ext insulin inf pump syr |
8,014 |
7,455 |
$186K |
| A4424 |
Ost pch drain w bar & filter |
2,490 |
2,338 |
$185K |
| A4432 |
Os pch urine w bar/fange/tap |
4,412 |
4,097 |
$177K |
| A9999 |
Dme supply or accessory, nos |
13,317 |
8,838 |
$172K |
| A5056 |
1 pc ost pouch w filter |
2,107 |
1,936 |
$166K |
| A5061 |
Pouch drainable w barrier at |
2,345 |
2,148 |
$153K |
| E2103 |
Non-adju cgm receiver/mon |
1,679 |
1,591 |
$153K |
| A4406 |
Pectin based ostomy paste |
8,652 |
8,257 |
$151K |
| A4389 |
Drainable pch w st wear barr |
1,835 |
1,662 |
$144K |
| A4217 |
Sterile water/saline, 500 ml |
14,808 |
14,140 |
$133K |
| A4310 |
Insert tray w/o bag/cath |
5,621 |
5,163 |
$130K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,341 |
2,182 |
$126K |
| A4373 |
Skin barrier with flange |
1,680 |
1,599 |
$126K |
| A4410 |
Ost skn barr extnd >4 sq |
1,065 |
1,012 |
$122K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
3,598 |
3,351 |
$115K |
| E1399 |
Durable medical equipment mi |
7,681 |
6,831 |
$113K |
| A4450 |
Non-waterproof tape |
18,368 |
17,603 |
$110K |
| A6216 |
Non-sterile gauze<=16 sq in |
19,453 |
17,996 |
$108K |
| A4390 |
Drainable pch ex wear convex |
1,060 |
984 |
$102K |
| E0240 |
Bath/shower chair |
2,396 |
2,366 |
$100K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
716 |
576 |
$99K |
| A4259 |
Lancets per box |
41,936 |
39,790 |
$98K |
| A6240 |
Hydrocolld drg filler paste |
1,943 |
1,871 |
$96K |
| A4388 |
Drainable pch w ex wear barr |
1,488 |
1,396 |
$92K |
| A6258 |
Transparent film >16<=48 in |
2,657 |
2,476 |
$91K |
| A6207 |
Contact layer >16<= 48 sq in |
1,726 |
1,577 |
$86K |
| E0607 |
Blood glucose monitor home |
2,262 |
2,213 |
$85K |
| A4427 |
Ost pch drain/barr lk flng/f |
2,077 |
1,954 |
$85K |
| A5073 |
Urinary pouch on barr w/flng |
1,130 |
1,105 |
$83K |
| A6250 |
Skin seal protect moisturizr |
8,242 |
7,878 |
$77K |
| A4256 |
Calibrator solution/chips |
13,772 |
13,178 |
$75K |
| A4322 |
Irrigation syringe |
3,189 |
2,887 |
$74K |
| B9998 |
Enteral supp not otherwise c |
734 |
624 |
$73K |
| A6454 |
Self-adher band w>=3" <5"/yd |
3,412 |
3,106 |
$73K |
| A6248 |
Hydrogel drsg gel filler |
2,408 |
2,302 |
$72K |
| A4371 |
Skin barrier powder per oz |
13,427 |
12,740 |
$72K |
| B4035 |
Enteral feed supp pump per d |
505 |
437 |
$71K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
5,573 |
5,160 |
$69K |
| A4221 |
Supp non-insulin inf cath/wk |
884 |
838 |
$65K |
| A4216 |
Sterile water/saline, 10 ml |
4,510 |
4,333 |
$64K |
| A5054 |
Clsd ostomy pouch w/flange |
775 |
734 |
$61K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
985 |
908 |
$58K |
| A4338 |
Indwelling catheter latex |
4,806 |
4,489 |
$55K |
| A4430 |
Ost urine pch w b/bltin conv |
628 |
545 |
$49K |
| A6457 |
Tubular dressing |
2,894 |
2,654 |
$48K |
| E0241 |
Bath tub wall rail |
1,989 |
1,769 |
$48K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
1,636 |
1,473 |
$48K |
| A4649 |
Surgical supplies |
1,332 |
1,242 |
$47K |
| A6219 |
Gauze <= 16 sq in w/border |
3,361 |
3,107 |
$42K |
| A6260 |
Wound cleanser any type/size |
2,515 |
2,351 |
$41K |
| A6450 |
Lt compres band >=5"/yd |
1,521 |
1,427 |
$40K |
| A4367 |
Ostomy belt |
7,125 |
6,823 |
$40K |
| A6452 |
High compres band w>=3"<5"yd |
654 |
585 |
$39K |
| B4100 |
Food thickener oral |
555 |
524 |
$39K |
| A4402 |
Lubricant per ounce |
6,534 |
6,238 |
$38K |
| A6022 |
Collagen drsg>16<=48 sq in |
283 |
268 |
$36K |
| E0143 |
Walker folding wheeled w/o s |
813 |
785 |
$35K |
| A4320 |
Irrigation tray |
2,616 |
2,412 |
$34K |
| A4416 |
Ost pch clsd w barrier/filtr |
493 |
433 |
$34K |
| B4102 |
Ef adult fluids and electro |
1,362 |
929 |
$32K |
| E0105 |
Cane adjust/fixed quad/3 pro |
1,072 |
1,059 |
$28K |
| A4396 |
Peristomal hernia supprt blt |
826 |
731 |
$27K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
991 |
951 |
$26K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
693 |
671 |
$26K |
| A4520 |
Incontinence garment anytype |
868 |
765 |
$23K |
| A4332 |
Lube sterile packet |
2,223 |
2,073 |
$23K |
| A6441 |
Pad band w>=3" <5"/yd |
1,860 |
1,663 |
$23K |
| A6261 |
Wound filler gel/paste /oz |
261 |
246 |
$22K |
| A4369 |
Skin barrier liquid per oz |
4,055 |
3,829 |
$22K |
| T4539 |
Reuse diaper/brief any size |
781 |
733 |
$21K |
| B4088 |
Gastro/jejuno tube, low-pro |
296 |
287 |
$21K |
| A4455 |
Adhesive remover per ounce |
4,246 |
4,023 |
$20K |
| E1639 |
Scale, each |
768 |
762 |
$19K |
| E0163 |
Commode chair with fixed arm |
442 |
434 |
$17K |
| A6217 |
Non-sterile gauze>16<=48 sq |
1,988 |
1,904 |
$15K |
| A4331 |
Extension drainage tubing |
2,367 |
2,220 |
$15K |
| A6259 |
Transparent film > 48 sq in |
146 |
142 |
$15K |
| A4245 |
Alcohol wipes per box |
8,538 |
8,366 |
$15K |
| A4333 |
Urinary cath anchor device |
1,878 |
1,765 |
$12K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
423 |
402 |
$12K |
| A4364 |
Adhesive, liquid or equal |
873 |
831 |
$11K |
| A4412 |
Ost pouch drain high output |
360 |
349 |
$10K |
| A4930 |
Sterile, gloves per pair |
678 |
646 |
$10K |
| A6257 |
Transparent film <= 16 sq in |
461 |
433 |
$9K |
| A4311 |
Catheter w/o bag 2-way latex |
849 |
779 |
$9K |
| A4411 |
Ost skn barr extnd =4sq |
187 |
175 |
$8K |
| A4334 |
Urinary cath leg strap |
1,367 |
1,255 |
$8K |
| A6407 |
Packing strips, non-impreg |
292 |
282 |
$7K |
| A4314 |
Cath w/drainage 2-way latex |
509 |
448 |
$6K |
| A6218 |
Non-sterile gauze > 48 sq in |
308 |
297 |
$6K |
| A4459 |
Transanal irrigation, any |
47 |
47 |
$5K |
| T4532 |
Ped size pull-on lg |
78 |
77 |
$5K |
| A4393 |
Urine pch w ex wear bar conv |
74 |
68 |
$5K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
32 |
26 |
$4K |
| A6447 |
Conform band s w >=5"/yd |
94 |
93 |
$4K |
| E0100 |
Cane adjust/fixed with tip |
321 |
320 |
$4K |
| A9281 |
Reaching/grabbing device |
173 |
171 |
$4K |
| A5052 |
Clsd ostomy pouch w/o barr |
54 |
52 |
$4K |
| E0244 |
Toilet seat raised |
63 |
63 |
$4K |
| A4400 |
Ostomy irrigation set |
52 |
50 |
$4K |
| A4404 |
Ostomy ring each |
182 |
173 |
$3K |
| A9270 |
Non-covered item or service |
2,508 |
2,203 |
$3K |
| E0245 |
Tub stool or bench |
67 |
66 |
$3K |
| A4413 |
2 pc drainable ost pouch |
44 |
37 |
$3K |
| A4405 |
Nonpectin based ostomy paste |
260 |
234 |
$2K |
| A4392 |
Urinary pouch w st wear barr |
40 |
36 |
$2K |
| A6203 |
Composite drsg <= 16 sq in |
69 |
66 |
$2K |
| A6445 |
Conform band s w <3"/yd |
183 |
173 |
$2K |
| A4231 |
Infusion insulin pump needle |
40 |
39 |
$2K |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
110 |
103 |
$2K |
| E0247 |
Trans bench w/wo comm open |
28 |
27 |
$2K |
| E0445 |
Oximeter non-invasive |
79 |
79 |
$2K |
| A6530 |
Compression stocking bk18-30 |
31 |
27 |
$2K |
| E0305 |
Rails bed side half length |
38 |
38 |
$2K |
| A4363 |
Ostomy clamp, replacement |
584 |
557 |
$2K |
| E0215 |
Electric heat pad moist |
28 |
28 |
$2K |
| A4428 |
Urine ost pouch w faucet/tap |
13 |
13 |
$2K |
| A4423 |
Ost pch for bar w lk fl/fltr |
13 |
12 |
$2K |
| A6545 |
Grad com non-elastic bk surg |
42 |
36 |
$1K |
| A5131 |
Appliance cleaner |
51 |
50 |
$1K |
| E0243 |
Toilet rail |
30 |
29 |
$1K |
| A6455 |
Self-adher band >=5"/yd |
28 |
25 |
$798.45 |
| B4036 |
Enteral feed sup kit grav by |
26 |
24 |
$757.17 |
| A6442 |
Conform band n/s w<3"/yd |
135 |
125 |
$626.34 |
| A5200 |
Percutaneous catheter anchor |
12 |
12 |
$437.08 |
| A4246 |
Betadine/phisohex solution |
63 |
62 |
$327.00 |
| A6448 |
Lt compres band <3"/yd |
13 |
12 |
$314.14 |
| A4258 |
Lancet device each |
30 |
27 |
$278.77 |
| E0325 |
Urinal male jug-type |
38 |
38 |
$210.49 |