| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
7,034 |
5,972 |
$1.13M |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
8,356 |
7,312 |
$873K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
11,060 |
9,586 |
$859K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
5,127 |
4,359 |
$587K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
7,649 |
6,628 |
$512K |
| 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 |
9,688 |
8,472 |
$459K |
| A6210 |
Foam 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 |
2,091 |
1,880 |
$363K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
20,697 |
18,071 |
$361K |
| 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 |
1,736 |
1,637 |
$318K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
18,374 |
16,629 |
$254K |
| 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 |
620 |
548 |
$246K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,934 |
1,812 |
$220K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,698 |
4,357 |
$204K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
4,880 |
4,394 |
$192K |
| A4452 |
Tape, waterproof, per 18 square inches |
21,131 |
18,967 |
$179K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
897 |
816 |
$146K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,370 |
2,276 |
$129K |
| 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 |
1,483 |
1,400 |
$119K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,802 |
1,642 |
$119K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,633 |
2,498 |
$110K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
18,356 |
16,665 |
$89K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,762 |
2,656 |
$88K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
902 |
811 |
$81K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
3,538 |
3,055 |
$80K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,233 |
1,130 |
$78K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,028 |
984 |
$76K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15,142 |
13,867 |
$70K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
638 |
526 |
$65K |
| A4927 |
Gloves, non-sterile, per 100 |
7,236 |
6,764 |
$61K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
727 |
651 |
$53K |
| B9998 |
Noc for enteral supplies |
1,172 |
980 |
$53K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,191 |
3,073 |
$52K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
983 |
863 |
$51K |
| 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 |
519 |
495 |
$51K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
963 |
885 |
$45K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
981 |
934 |
$44K |
| 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 |
497 |
446 |
$43K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
139 |
116 |
$40K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,608 |
3,261 |
$39K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
5,261 |
5,033 |
$39K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
642 |
585 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
563 |
549 |
$31K |
| B9002 |
Enteral nutrition infusion pump, any type |
760 |
643 |
$29K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
601 |
460 |
$29K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
448 |
440 |
$23K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
681 |
612 |
$23K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,809 |
1,558 |
$23K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,599 |
1,547 |
$22K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,132 |
3,008 |
$20K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
4,277 |
4,114 |
$19K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,622 |
1,568 |
$17K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,041 |
4,810 |
$17K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
37 |
37 |
$14K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
411 |
359 |
$11K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
1,005 |
829 |
$10K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
409 |
384 |
$10K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,393 |
1,289 |
$10K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,601 |
3,425 |
$10K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
2,179 |
2,119 |
$9K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
102 |
99 |
$9K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
506 |
460 |
$9K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,801 |
3,398 |
$8K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,662 |
2,576 |
$8K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
517 |
469 |
$8K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
893 |
751 |
$7K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
100 |
94 |
$7K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
568 |
491 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,454 |
1,410 |
$7K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
683 |
584 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
81 |
79 |
$6K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
158 |
137 |
$5K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
82 |
82 |
$5K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
86 |
85 |
$5K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
433 |
393 |
$5K |
| A4322 |
Irrigation syringe, bulb or piston, each |
318 |
295 |
$5K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
127 |
124 |
$4K |
| A4332 |
Lubricant, individual sterile packet, each |
680 |
639 |
$4K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
274 |
267 |
$4K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,709 |
1,651 |
$4K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
28 |
24 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
122 |
113 |
$3K |
| A4367 |
Ostomy belt, each |
635 |
609 |
$2K |
| E0776 |
Iv pole |
325 |
299 |
$2K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
12 |
12 |
$2K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,647 |
1,496 |
$2K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
194 |
141 |
$1K |
| A4670 |
Automatic blood pressure monitor |
20 |
20 |
$1K |
| A6242 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$620.84 |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
48 |
42 |
$329.57 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
53 |
50 |
$308.88 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
39 |
38 |
$77.61 |
| A6260 |
Wound cleansers, any type, any size |
20 |
18 |
$21.28 |
| A9270 |
Non-covered item or service |
123 |
113 |
$1.00 |