| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
External ambulatory infusion pump, insulin |
3,854 |
3,597 |
$4.81M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
11,527 |
11,173 |
$4.53M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
6,518 |
5,960 |
$2.62M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
13,147 |
12,765 |
$1.27M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
9,181 |
8,629 |
$1.19M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,025 |
6,757 |
$878K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,633 |
2,465 |
$802K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,483 |
4,245 |
$766K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
7,268 |
6,942 |
$695K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,923 |
4,755 |
$675K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,076 |
5,855 |
$667K |
| A4231 |
Infusion set for external insulin pump, needle type |
1,661 |
1,602 |
$603K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
1,037 |
953 |
$602K |
| S9999 |
Sales tax |
53,541 |
46,873 |
$436K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,632 |
5,389 |
$359K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,229 |
1,160 |
$264K |
| E0570 |
Nebulizer, with compressor |
7,256 |
7,103 |
$244K |
| A4927 |
Gloves, non-sterile, per 100 |
7,042 |
6,745 |
$219K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,283 |
2,202 |
$202K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,754 |
5,543 |
$187K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,652 |
1,585 |
$183K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,342 |
1,277 |
$170K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,696 |
1,665 |
$159K |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
690 |
664 |
$152K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,140 |
1,112 |
$142K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,295 |
4,201 |
$114K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
589 |
586 |
$111K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,521 |
1,418 |
$107K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
260 |
236 |
$98K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
976 |
929 |
$87K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,447 |
1,377 |
$86K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,834 |
1,711 |
$83K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
860 |
822 |
$72K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
851 |
803 |
$68K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
393 |
373 |
$61K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,465 |
1,340 |
$59K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
926 |
893 |
$59K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,792 |
4,604 |
$49K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
810 |
771 |
$43K |
| E1399 |
Durable medical equipment, miscellaneous |
1,622 |
1,303 |
$43K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
53 |
49 |
$43K |
| A7031 |
Face mask interface, replacement for full face mask, each |
864 |
832 |
$36K |
| A7030 |
Full face mask used with positive airway pressure device, each |
376 |
366 |
$33K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
275 |
259 |
$32K |
| 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 |
46 |
44 |
$28K |
| E0601 |
Continuous positive airway pressure (cpap) device |
488 |
476 |
$28K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
303 |
281 |
$28K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
952 |
920 |
$27K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
697 |
666 |
$26K |
| K0001 |
Standard wheelchair |
1,253 |
1,171 |
$25K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,636 |
1,535 |
$24K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
659 |
636 |
$23K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
718 |
699 |
$22K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
139 |
138 |
$22K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
537 |
524 |
$21K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,385 |
1,345 |
$18K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,769 |
1,683 |
$18K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
107 |
105 |
$17K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
740 |
699 |
$17K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
72 |
67 |
$16K |
| 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 |
99 |
88 |
$14K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,259 |
1,178 |
$11K |
| A4670 |
Automatic blood pressure monitor |
176 |
163 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,644 |
1,600 |
$9K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
312 |
277 |
$8K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
193 |
180 |
$7K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
26 |
24 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
768 |
733 |
$7K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
13 |
12 |
$7K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
292 |
291 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
54 |
50 |
$6K |
| A4245 |
Alcohol wipes, per box |
2,365 |
2,286 |
$5K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
469 |
460 |
$5K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
26 |
25 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
348 |
331 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
204 |
199 |
$3K |
| E0156 |
Seat attachment, walker |
313 |
294 |
$3K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
26 |
24 |
$3K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
12 |
12 |
$3K |
| A4332 |
Lubricant, individual sterile packet, each |
84 |
78 |
$2K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
14 |
12 |
$1K |
| A4367 |
Ostomy belt, each |
246 |
236 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
135 |
129 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
90 |
87 |
$1K |
| E0605 |
Vaporizer, room type |
42 |
42 |
$964.96 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
134 |
128 |
$824.52 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
88 |
81 |
$734.53 |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
13 |
12 |
$583.86 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
13 |
13 |
$580.92 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
242 |
239 |
$517.19 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
42 |
37 |
$468.44 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
12 |
12 |
$454.69 |
| A7037 |
Tubing used with positive airway pressure device |
15 |
15 |
$340.43 |
| A4259 |
Lancets, per box of 100 |
198 |
191 |
$141.80 |
| A4256 |
Normal, low and high calibrator solution / chips |
66 |
50 |
$138.08 |
| A4258 |
Spring-powered device for lancet, each |
16 |
16 |
$134.11 |
| A9270 |
Non-covered item or service |
215 |
140 |
$0.00 |