| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
756 |
719 |
$61K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
277 |
262 |
$44K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
401 |
331 |
$41K |
| A6023 |
Collagen dressing, sterile, size more than 48 sq. in., each |
135 |
107 |
$24K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
266 |
216 |
$19K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
580 |
559 |
$19K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
519 |
501 |
$14K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
299 |
243 |
$12K |
| A6233 |
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing |
135 |
114 |
$12K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
144 |
140 |
$10K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
213 |
177 |
$7K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
485 |
473 |
$7K |
| A6205 |
Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
94 |
76 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
233 |
203 |
$4K |
| 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 |
72 |
60 |
$4K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
31 |
26 |
$3K |
| E0570 |
Nebulizer, with compressor |
39 |
39 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
373 |
323 |
$3K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
46 |
39 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
164 |
136 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
109 |
96 |
$2K |
| A4930 |
Gloves, sterile, per pair |
118 |
101 |
$953.06 |
| A5120 |
Skin barrier, wipes or swabs, each |
60 |
53 |
$552.30 |
| A4927 |
Gloves, non-sterile, per 100 |
154 |
131 |
$496.28 |
| A4245 |
Alcohol wipes, per box |
44 |
38 |
$200.13 |