| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
7,034 |
5,972 |
$1.13M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
8,356 |
7,312 |
$873K |
| A6212 |
Foam drg <=16 sq in w/border |
11,060 |
9,586 |
$859K |
| A6021 |
Collagen dressing <=16 sq in |
5,127 |
4,359 |
$587K |
| A6196 |
Alginate dressing <=16 sq in |
7,649 |
6,628 |
$512K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
9,688 |
8,472 |
$459K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,091 |
1,880 |
$363K |
| A6446 |
Conform band s w>=3" <5"/yd |
20,697 |
18,071 |
$361K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,736 |
1,637 |
$318K |
| A4216 |
Sterile water/saline, 10 ml |
18,374 |
16,629 |
$254K |
| B4161 |
Ef ped hydrolyzed/amino acid |
620 |
548 |
$246K |
| A4351 |
Straight tip urine catheter |
1,934 |
1,812 |
$220K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
4,698 |
4,357 |
$204K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
4,880 |
4,394 |
$192K |
| A4452 |
Waterproof tape |
21,131 |
18,967 |
$179K |
| B4035 |
Enteral feed supp pump per d |
897 |
816 |
$146K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,370 |
2,276 |
$129K |
| B4150 |
Ef complet w/intact nutrient |
1,483 |
1,400 |
$119K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,802 |
1,642 |
$119K |
| A4385 |
Ost skn barrier sld ext wear |
2,633 |
2,498 |
$110K |
| A6402 |
Sterile gauze <= 16 sq in |
18,356 |
16,665 |
$89K |
| A4425 |
Ost pch drain for barrier fl |
2,762 |
2,656 |
$88K |
| A6199 |
Alginate drsg wound filler |
902 |
811 |
$81K |
| A6449 |
Lt compres band >=3" <5"/yd |
3,538 |
3,055 |
$80K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,233 |
1,130 |
$78K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,028 |
984 |
$76K |
| A6216 |
Non-sterile gauze<=16 sq in |
15,142 |
13,867 |
$70K |
| A6452 |
High compres band w>=3"<5"yd |
638 |
526 |
$65K |
| A4927 |
Non-sterile gloves |
7,236 |
6,764 |
$61K |
| A6207 |
Contact layer >16<= 48 sq in |
727 |
651 |
$53K |
| B9998 |
Enteral supp not otherwise c |
1,172 |
980 |
$53K |
| T4541 |
Large disposable underpad |
3,191 |
3,073 |
$52K |
| A6258 |
Transparent film >16<=48 in |
983 |
863 |
$51K |
| B4152 |
Ef calorie dense>/=1.5kcal |
519 |
495 |
$51K |
| A6217 |
Non-sterile gauze>16<=48 sq |
963 |
885 |
$45K |
| A5056 |
1 pc ost pouch w filter |
981 |
934 |
$44K |
| B4154 |
Ef spec metabolic noninherit |
497 |
446 |
$43K |
| A4353 |
Intermittent urinary cath |
139 |
116 |
$40K |
| A6219 |
Gauze <= 16 sq in w/border |
3,608 |
3,261 |
$39K |
| A4314 |
Cath w/drainage 2-way latex |
5,261 |
5,033 |
$39K |
| A6203 |
Composite drsg <= 16 sq in |
642 |
585 |
$33K |
| T4526 |
Adult size pull-on med |
563 |
549 |
$31K |
| B9002 |
Enter nutr inf pump any type |
760 |
643 |
$29K |
| A6450 |
Lt compres band >=5"/yd |
601 |
460 |
$29K |
| T4527 |
Adult size pull-on lg |
448 |
440 |
$23K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
681 |
612 |
$23K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,809 |
1,558 |
$23K |
| A4362 |
Solid skin barrier |
1,599 |
1,547 |
$22K |
| A4456 |
Adhesive remover, wipes |
3,132 |
3,008 |
$20K |
| A4357 |
Bedside drainage bag |
4,277 |
4,114 |
$19K |
| A4394 |
Ostomy pouch liq deodorant |
1,622 |
1,568 |
$17K |
| A5120 |
Skin barrier, wipe or swab |
5,041 |
4,810 |
$17K |
| A4352 |
Coude tip urinary catheter |
37 |
37 |
$14K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
411 |
359 |
$11K |
| A6407 |
Packing strips, non-impreg |
1,005 |
829 |
$10K |
| A6248 |
Hydrogel drsg gel filler |
409 |
384 |
$10K |
| A6457 |
Tubular dressing |
1,393 |
1,289 |
$10K |
| A4358 |
Urinary leg or abdomen bag |
3,601 |
3,425 |
$10K |
| A4333 |
Urinary cath anchor device |
2,179 |
2,119 |
$9K |
| T4534 |
Youth size pull-on |
102 |
99 |
$9K |
| B4088 |
Gastro/jejuno tube, low-pro |
506 |
460 |
$9K |
| A4450 |
Non-waterproof tape |
3,801 |
3,398 |
$8K |
| A4320 |
Irrigation tray |
2,662 |
2,576 |
$8K |
| A4349 |
Disposable male external cat |
517 |
469 |
$8K |
| A6441 |
Pad band w>=3" <5"/yd |
893 |
751 |
$7K |
| T4530 |
Ped size brief/diaper lg |
100 |
94 |
$7K |
| A6445 |
Conform band s w <3"/yd |
568 |
491 |
$7K |
| A4406 |
Pectin based ostomy paste |
1,454 |
1,410 |
$7K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
683 |
584 |
$6K |
| T4528 |
Adult size pull-on xl |
81 |
79 |
$6K |
| A6545 |
Grad com non-elastic bk surg |
158 |
137 |
$5K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
82 |
82 |
$5K |
| T4523 |
Adult size brief/diaper lg |
86 |
85 |
$5K |
| A6240 |
Hydrocolld drg filler paste |
433 |
393 |
$5K |
| A4322 |
Irrigation syringe |
318 |
295 |
$5K |
| A4432 |
Os pch urine w bar/fange/tap |
127 |
124 |
$4K |
| A4332 |
Lube sterile packet |
680 |
639 |
$4K |
| A4315 |
Cath w/drainage 2-way silcne |
274 |
267 |
$4K |
| A4371 |
Skin barrier powder per oz |
1,709 |
1,651 |
$4K |
| B4036 |
Enteral feed sup kit grav by |
28 |
24 |
$3K |
| T4537 |
Reusable underpad bed size |
122 |
113 |
$3K |
| A4367 |
Ostomy belt |
635 |
609 |
$2K |
| E0776 |
Iv pole |
325 |
299 |
$2K |
| T4544 |
Adlt disp und/pull on abv xl |
12 |
12 |
$2K |
| A4334 |
Urinary cath leg strap |
1,647 |
1,496 |
$2K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
194 |
141 |
$1K |
| A4670 |
Automatic bp monitor, dial |
20 |
20 |
$1K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
13 |
12 |
$620.84 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
48 |
42 |
$329.57 |
| A6257 |
Transparent film <= 16 sq in |
53 |
50 |
$308.88 |
| A4310 |
Insert tray w/o bag/cath |
39 |
38 |
$77.61 |
| A6260 |
Wound cleanser any type/size |
20 |
18 |
$21.28 |
| A9270 |
Non-covered item or service |
123 |
113 |
$1.00 |