| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
19,603 |
18,847 |
$1.29M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,196 |
8,623 |
$932K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,687 |
8,225 |
$693K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,392 |
11,756 |
$610K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,506 |
5,201 |
$600K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
859 |
807 |
$181K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,016 |
3,849 |
$165K |
| A4927 |
Gloves, non-sterile, per 100 |
30,377 |
28,966 |
$140K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
695 |
682 |
$92K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
543 |
536 |
$68K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,709 |
1,523 |
$59K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
956 |
790 |
$59K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
527 |
437 |
$50K |
| 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 |
954 |
865 |
$36K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,527 |
1,513 |
$33K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
945 |
846 |
$30K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,055 |
940 |
$30K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
602 |
518 |
$27K |
| 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 |
265 |
241 |
$22K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,083 |
2,726 |
$22K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
264 |
255 |
$19K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
690 |
605 |
$18K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
701 |
630 |
$16K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
766 |
683 |
$15K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,139 |
1,008 |
$14K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
940 |
799 |
$12K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,202 |
1,988 |
$11K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
152 |
146 |
$10K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,108 |
996 |
$10K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,486 |
2,233 |
$9K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,512 |
1,332 |
$8K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
949 |
833 |
$7K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
659 |
598 |
$6K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
936 |
801 |
$6K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
735 |
650 |
$6K |
| A4245 |
Alcohol wipes, per box |
990 |
930 |
$5K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
87 |
78 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,287 |
1,137 |
$5K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
73 |
70 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
152 |
118 |
$4K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
48 |
46 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
422 |
377 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
461 |
434 |
$3K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
19 |
19 |
$3K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
31 |
26 |
$3K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
41 |
38 |
$2K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
91 |
80 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
912 |
822 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
44 |
40 |
$2K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
75 |
67 |
$2K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
30 |
25 |
$1K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
34 |
29 |
$1K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
15 |
15 |
$934.56 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
30 |
26 |
$814.11 |
| A4367 |
Ostomy belt, each |
238 |
207 |
$706.16 |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
15 |
12 |
$693.76 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
23 |
15 |
$680.68 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13 |
12 |
$562.75 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
150 |
140 |
$545.53 |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14 |
12 |
$405.12 |
| 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 |
16 |
15 |
$337.43 |
| A4623 |
Tracheostomy, inner cannula |
13 |
12 |
$254.67 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
36 |
33 |
$240.93 |
| A7526 |
Tracheostomy tube collar/holder, each |
57 |
51 |
$178.20 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
13 |
12 |
$111.65 |
| A6260 |
Wound cleansers, any type, any size |
15 |
12 |
$102.21 |
| A4259 |
Lancets, per box of 100 |
17 |
16 |
$82.97 |
| A4402 |
Lubricant, per ounce |
13 |
12 |
$43.17 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
13 |
12 |
$0.00 |