| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12,622 |
12,423 |
$1.52M |
| T4541 |
Incontinence product, disposable underpad, large, each |
13,190 |
13,053 |
$1.02M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,265 |
6,180 |
$789K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,998 |
4,887 |
$697K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
5,873 |
5,781 |
$682K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,131 |
3,054 |
$564K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,441 |
4,405 |
$540K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,954 |
2,903 |
$511K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,038 |
3,986 |
$507K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,658 |
3,611 |
$495K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,708 |
2,672 |
$408K |
| A4927 |
Gloves, non-sterile, per 100 |
17,391 |
16,952 |
$407K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,884 |
9,701 |
$255K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,397 |
1,352 |
$246K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
995 |
987 |
$146K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,058 |
1,040 |
$144K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
918 |
901 |
$134K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
682 |
665 |
$70K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
1,918 |
1,723 |
$68K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
667 |
625 |
$61K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
163 |
160 |
$56K |
| G2023 |
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,619 |
2,312 |
$53K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
573 |
549 |
$36K |
| A4554 |
Disposable underpads, all sizes |
1,243 |
1,220 |
$32K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
696 |
666 |
$26K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
83 |
77 |
$26K |
| K0001 |
Standard wheelchair |
1,174 |
1,138 |
$20K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
218 |
217 |
$17K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,178 |
1,100 |
$12K |
| 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 |
78 |
77 |
$11K |
| E0570 |
Nebulizer, with compressor |
642 |
616 |
$10K |
| V5266 |
Battery for use in hearing device |
557 |
547 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
821 |
752 |
$7K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
115 |
113 |
$7K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
92 |
91 |
$6K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
41 |
39 |
$5K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
121 |
121 |
$5K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
29 |
26 |
$5K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
19 |
18 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
182 |
160 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
535 |
500 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
549 |
528 |
$4K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
76 |
68 |
$3K |
| E0607 |
Home blood glucose monitor |
50 |
49 |
$3K |
| A4456 |
Adhesive remover, wipes, any type, each |
242 |
236 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
187 |
172 |
$2K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
118 |
117 |
$2K |
| A4402 |
Lubricant, per ounce |
330 |
321 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
95 |
95 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$1K |
| A4215 |
Needle, sterile, any size, each |
19 |
19 |
$1K |
| A4670 |
Automatic blood pressure monitor |
17 |
17 |
$977.84 |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
13 |
12 |
$956.88 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
17 |
12 |
$930.44 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
34 |
34 |
$843.84 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
13 |
12 |
$733.18 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
62 |
62 |
$530.06 |
| A4245 |
Alcohol wipes, per box |
25 |
25 |
$335.17 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
14 |
13 |
$295.89 |
| A4259 |
Lancets, per box of 100 |
165 |
156 |
$290.27 |
| A7015 |
Aerosol mask, used with dme nebulizer |
147 |
147 |
$225.75 |
| A4371 |
Ostomy skin barrier, powder, per oz |
82 |
78 |
$201.33 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
100 |
100 |
$101.41 |
| A4258 |
Spring-powered device for lancet, each |
46 |
45 |
$77.47 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14 |
14 |
$49.26 |
| 0002A |
|
29 |
29 |
$37.25 |
| 90688 |
|
20 |
20 |
$36.82 |
| 90686 |
|
89 |
89 |
$20.52 |
| G0008 |
Administration of influenza virus vaccine |
433 |
433 |
$17.40 |
| 0012A |
|
338 |
338 |
$17.07 |
| 0011A |
|
335 |
331 |
$3.30 |
| 90694 |
|
120 |
120 |
$0.00 |
| 90656 |
|
29 |
29 |
$0.00 |
| 0064A |
|
467 |
467 |
$0.00 |
| 90480 |
|
188 |
188 |
$0.00 |
| 90674 |
|
63 |
63 |
$0.00 |
| 0134A |
|
67 |
67 |
$0.00 |
| 0001A |
|
22 |
22 |
$0.00 |
| 0124A |
|
30 |
30 |
$0.00 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
16 |
15 |
$0.00 |
| 0054A |
|
12 |
12 |
$0.00 |
| 91320 |
|
66 |
66 |
$0.00 |
| 91322 |
|
103 |
103 |
$0.00 |
| 90661 |
|
17 |
17 |
$0.00 |
| 0004A |
|
30 |
30 |
$0.00 |
| 90653 |
|
41 |
41 |
$0.00 |