| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
19,603 |
18,847 |
$1.29M |
| T4523 |
Adult size brief/diaper lg |
9,196 |
8,623 |
$932K |
| T4522 |
Adult size brief/diaper med |
8,687 |
8,225 |
$693K |
| T4535 |
Disposable liner/shield/pad |
12,392 |
11,756 |
$610K |
| T4524 |
Adult size brief/diaper xl |
5,506 |
5,201 |
$600K |
| T4543 |
Adult disp brief/diap abv xl |
859 |
807 |
$181K |
| T4537 |
Reusable underpad bed size |
4,016 |
3,849 |
$165K |
| A4927 |
Non-sterile gloves |
30,377 |
28,966 |
$140K |
| K0553 |
Ther cgm supply allowance |
695 |
682 |
$92K |
| E0603 |
Electric breast pump |
543 |
536 |
$68K |
| A4385 |
Ost skn barrier sld ext wear |
1,709 |
1,523 |
$59K |
| A6212 |
Foam drg <=16 sq in w/border |
956 |
790 |
$59K |
| A4351 |
Straight tip urine catheter |
527 |
437 |
$50K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
954 |
865 |
$36K |
| T4540 |
Reusable underpad chair size |
1,527 |
1,513 |
$33K |
| A4409 |
Ost skn barr convex <=4 sq i |
945 |
846 |
$30K |
| A4425 |
Ost pch drain for barrier fl |
1,055 |
940 |
$30K |
| A4407 |
Ext wear ost skn barr <=4sq" |
602 |
518 |
$27K |
| A6197 |
Alginate drsg >16 <=48 sq in |
265 |
241 |
$22K |
| A6402 |
Sterile gauze <= 16 sq in |
3,083 |
2,726 |
$22K |
| T4521 |
Adult size brief/diaper sm |
264 |
255 |
$19K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
690 |
605 |
$18K |
| A4362 |
Solid skin barrier |
701 |
630 |
$16K |
| A5063 |
Drain ostomy pouch w/flange |
766 |
683 |
$15K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,139 |
1,008 |
$14K |
| A4216 |
Sterile water/saline, 10 ml |
940 |
799 |
$12K |
| A4357 |
Bedside drainage bag |
2,202 |
1,988 |
$11K |
| T4534 |
Youth size pull-on |
152 |
146 |
$10K |
| A4452 |
Waterproof tape |
1,108 |
996 |
$10K |
| A5120 |
Skin barrier, wipe or swab |
2,486 |
2,233 |
$9K |
| A4456 |
Adhesive remover, wipes |
1,512 |
1,332 |
$8K |
| A4314 |
Cath w/drainage 2-way latex |
949 |
833 |
$7K |
| A4358 |
Urinary leg or abdomen bag |
659 |
598 |
$6K |
| A4406 |
Pectin based ostomy paste |
936 |
801 |
$6K |
| A4394 |
Ostomy pouch liq deodorant |
735 |
650 |
$6K |
| A4245 |
Alcohol wipes per box |
990 |
930 |
$5K |
| A4424 |
Ost pch drain w bar & filter |
87 |
78 |
$5K |
| A4450 |
Non-waterproof tape |
1,287 |
1,137 |
$5K |
| T4533 |
Youth size brief/diaper |
73 |
70 |
$4K |
| T4541 |
Large disposable underpad |
152 |
118 |
$4K |
| T4526 |
Adult size pull-on med |
48 |
46 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
422 |
377 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
461 |
434 |
$3K |
| K0554 |
Ther cgm receiver/monitor |
19 |
19 |
$3K |
| A6021 |
Collagen dressing <=16 sq in |
31 |
26 |
$3K |
| A5121 |
Solid skin barrier 6x6 |
41 |
38 |
$2K |
| A4419 |
Ost pch for bar w flange/flt |
91 |
80 |
$2K |
| A4371 |
Skin barrier powder per oz |
912 |
822 |
$2K |
| A4253 |
Blood glucose/reagent strips |
44 |
40 |
$2K |
| A4349 |
Disposable male external cat |
75 |
67 |
$2K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
30 |
25 |
$1K |
| A4432 |
Os pch urine w bar/fange/tap |
34 |
29 |
$1K |
| T4530 |
Ped size brief/diaper lg |
15 |
15 |
$934.56 |
| A5061 |
Pouch drainable w barrier at |
30 |
26 |
$814.11 |
| A4367 |
Ostomy belt |
238 |
207 |
$706.16 |
| A5057 |
1 pc ost pou w built-in conv |
15 |
12 |
$693.76 |
| A6196 |
Alginate dressing <=16 sq in |
23 |
15 |
$680.68 |
| T4528 |
Adult size pull-on xl |
13 |
12 |
$562.75 |
| A4333 |
Urinary cath anchor device |
150 |
140 |
$545.53 |
| T4527 |
Adult size pull-on lg |
14 |
12 |
$405.12 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
16 |
15 |
$337.43 |
| A4623 |
Tracheostomy inner cannula |
13 |
12 |
$254.67 |
| A6219 |
Gauze <= 16 sq in w/border |
36 |
33 |
$240.93 |
| A7526 |
Tracheostomy tube collar |
57 |
51 |
$178.20 |
| A4629 |
Tracheostomy care kit |
13 |
12 |
$111.65 |
| A6260 |
Wound cleanser any type/size |
15 |
12 |
$102.21 |
| A4259 |
Lancets per box |
17 |
16 |
$82.97 |
| A4402 |
Lubricant per ounce |
13 |
12 |
$43.17 |
| A4310 |
Insert tray w/o bag/cath |
13 |
12 |
$0.00 |