| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,866 |
2,762 |
$465K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
561 |
411 |
$356K |
| A4554 |
Disposable underpads, all sizes |
4,320 |
3,740 |
$245K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,201 |
1,780 |
$155K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
987 |
885 |
$125K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,023 |
846 |
$101K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
717 |
619 |
$97K |
| A9270 |
Non-covered item or service |
50 |
40 |
$89K |
| A4453 |
Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
34 |
26 |
$48K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,056 |
837 |
$43K |
| A4927 |
Gloves, non-sterile, per 100 |
2,121 |
1,847 |
$39K |
| A4217 |
Sterile water/saline, 500 ml |
560 |
431 |
$38K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,171 |
1,661 |
$32K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,495 |
2,726 |
$27K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
301 |
231 |
$19K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
299 |
238 |
$19K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,818 |
1,365 |
$18K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
36 |
26 |
$17K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,106 |
755 |
$17K |
| A4459 |
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
94 |
77 |
$15K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
120 |
87 |
$14K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,110 |
2,423 |
$13K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,180 |
929 |
$13K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
240 |
192 |
$11K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,908 |
1,442 |
$9K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
854 |
622 |
$6K |
| A4367 |
Ostomy belt, each |
778 |
554 |
$3K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
93 |
76 |
$2K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
14 |
12 |
$2K |
| A4402 |
Lubricant, per ounce |
16 |
12 |
$51.31 |