| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
Ext amb infusn pump insulin |
3,854 |
3,597 |
$4.81M |
| A4230 |
Infus insulin pump non needl |
11,527 |
11,173 |
$4.53M |
| A9276 |
Disposable sensor, cgm sys |
6,518 |
5,960 |
$2.62M |
| A4232 |
Syringe w/needle insulin 3cc |
13,147 |
12,765 |
$1.27M |
| K0553 |
Ther cgm supply allowance |
9,181 |
8,629 |
$1.19M |
| T4527 |
Adult size pull-on lg |
7,025 |
6,757 |
$878K |
| A4351 |
Straight tip urine catheter |
2,633 |
2,465 |
$802K |
| T4534 |
Youth size pull-on |
4,483 |
4,245 |
$766K |
| A4239 |
Non-adju cgm supply allow |
7,268 |
6,942 |
$695K |
| T4528 |
Adult size pull-on xl |
4,923 |
4,755 |
$675K |
| T4526 |
Adult size pull-on med |
6,076 |
5,855 |
$667K |
| A4231 |
Infusion insulin pump needle |
1,661 |
1,602 |
$603K |
| A9277 |
External transmitter, cgm |
1,037 |
953 |
$602K |
| S9999 |
Sales tax |
53,541 |
46,873 |
$436K |
| T4535 |
Disposable liner/shield/pad |
5,632 |
5,389 |
$359K |
| T4544 |
Adlt disp und/pull on abv xl |
1,229 |
1,160 |
$264K |
| E0570 |
Nebulizer with compression |
7,256 |
7,103 |
$244K |
| A4927 |
Non-sterile gloves |
7,042 |
6,745 |
$219K |
| A4385 |
Ost skn barrier sld ext wear |
2,283 |
2,202 |
$202K |
| T4541 |
Large disposable underpad |
5,754 |
5,543 |
$187K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,652 |
1,585 |
$183K |
| T4525 |
Adult size pull-on sm |
1,342 |
1,277 |
$170K |
| A6257 |
Transparent film <= 16 sq in |
1,696 |
1,665 |
$159K |
| A4238 |
Adju cgm supply allowance |
690 |
664 |
$152K |
| T4523 |
Adult size brief/diaper lg |
1,140 |
1,112 |
$142K |
| T4537 |
Reusable underpad bed size |
4,295 |
4,201 |
$114K |
| E0603 |
Electric breast pump |
589 |
586 |
$111K |
| A4425 |
Ost pch drain for barrier fl |
1,521 |
1,418 |
$107K |
| A6212 |
Foam drg <=16 sq in w/border |
260 |
236 |
$98K |
| A4362 |
Solid skin barrier |
976 |
929 |
$87K |
| A6530 |
Compression stocking bk18-30 |
1,447 |
1,377 |
$86K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,834 |
1,711 |
$83K |
| T4522 |
Adult size brief/diaper med |
860 |
822 |
$72K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
851 |
803 |
$68K |
| A4407 |
Ext wear ost skn barr <=4sq" |
393 |
373 |
$61K |
| A4452 |
Waterproof tape |
1,465 |
1,340 |
$59K |
| A4224 |
Supply insulin inf cath/wk |
926 |
893 |
$59K |
| A5120 |
Skin barrier, wipe or swab |
4,792 |
4,604 |
$49K |
| A5063 |
Drain ostomy pouch w/flange |
810 |
771 |
$43K |
| E1399 |
Durable medical equipment mi |
1,622 |
1,303 |
$43K |
| A4352 |
Coude tip urinary catheter |
53 |
49 |
$43K |
| A7031 |
Replacement facemask interfa |
864 |
832 |
$36K |
| A7030 |
Cpap full face mask |
376 |
366 |
$33K |
| K0554 |
Ther cgm receiver/monitor |
275 |
259 |
$32K |
| A6197 |
Alginate drsg >16 <=48 sq in |
46 |
44 |
$28K |
| E0601 |
Cont airway pressure device |
488 |
476 |
$28K |
| E2103 |
Non-adju cgm receiver/mon |
303 |
281 |
$28K |
| A4225 |
Sup/ext insulin inf pump syr |
952 |
920 |
$27K |
| A4394 |
Ostomy pouch liq deodorant |
697 |
666 |
$26K |
| K0001 |
Standard wheelchair |
1,253 |
1,171 |
$25K |
| A4357 |
Bedside drainage bag |
1,636 |
1,535 |
$24K |
| E0143 |
Walker folding wheeled w/o s |
659 |
636 |
$23K |
| A4604 |
Tubing with heating element |
718 |
699 |
$22K |
| T4532 |
Ped size pull-on lg |
139 |
138 |
$22K |
| E0261 |
Hosp bed semi-electr w/o mat |
537 |
524 |
$21K |
| A4456 |
Adhesive remover, wipes |
1,385 |
1,345 |
$18K |
| A4253 |
Blood glucose/reagent strips |
1,769 |
1,683 |
$18K |
| A5057 |
1 pc ost pou w built-in conv |
107 |
105 |
$17K |
| A4406 |
Pectin based ostomy paste |
740 |
699 |
$17K |
| A9279 |
Monitoring feature/devicenoc |
72 |
67 |
$16K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
99 |
88 |
$14K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,259 |
1,178 |
$11K |
| A4670 |
Automatic bp monitor, dial |
176 |
163 |
$10K |
| A7038 |
Pos airway pressure filter |
1,644 |
1,600 |
$9K |
| A6250 |
Skin seal protect moisturizr |
312 |
277 |
$8K |
| A6446 |
Conform band s w>=3" <5"/yd |
193 |
180 |
$7K |
| T4543 |
Adult disp brief/diap abv xl |
26 |
24 |
$7K |
| A4371 |
Skin barrier powder per oz |
768 |
733 |
$7K |
| A9278 |
External receiver, cgm sys |
13 |
12 |
$7K |
| K1005 |
Disp col sto bag breast milk |
292 |
291 |
$6K |
| T4524 |
Adult size brief/diaper xl |
54 |
50 |
$6K |
| A4245 |
Alcohol wipes per box |
2,365 |
2,286 |
$5K |
| E0149 |
Heavy duty wheeled walker |
469 |
460 |
$5K |
| A4419 |
Ost pch for bar w flange/flt |
26 |
25 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
348 |
331 |
$4K |
| A7035 |
Pos airway press headgear |
204 |
199 |
$3K |
| E0156 |
Walker seat attachment |
313 |
294 |
$3K |
| T4531 |
Ped size pull-on sm/med |
26 |
24 |
$3K |
| A6196 |
Alginate dressing <=16 sq in |
12 |
12 |
$3K |
| A4332 |
Lube sterile packet |
84 |
78 |
$2K |
| A6258 |
Transparent film >16<=48 in |
14 |
12 |
$1K |
| A4367 |
Ostomy belt |
246 |
236 |
$1K |
| A7046 |
Repl water chamber, pap dev |
135 |
129 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
90 |
87 |
$1K |
| E0605 |
Vaporizer room type |
42 |
42 |
$964.96 |
| A7039 |
Filter, non disposable w pap |
134 |
128 |
$824.52 |
| A4450 |
Non-waterproof tape |
88 |
81 |
$734.53 |
| A4432 |
Os pch urine w bar/fange/tap |
13 |
12 |
$583.86 |
| A7032 |
Replacement nasal cushion |
13 |
13 |
$580.92 |
| A7003 |
Nebulizer administration set |
242 |
239 |
$517.19 |
| K0195 |
Elevating whlchair leg rests |
42 |
37 |
$468.44 |
| L3908 |
Who cock-up nonmolde pre ots |
12 |
12 |
$454.69 |
| A7037 |
Pos airway pressure tubing |
15 |
15 |
$340.43 |
| A4259 |
Lancets per box |
198 |
191 |
$141.80 |
| A4256 |
Calibrator solution/chips |
66 |
50 |
$138.08 |
| A4258 |
Lancet device each |
16 |
16 |
$134.11 |
| A9270 |
Non-covered item or service |
215 |
140 |
$0.00 |