| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
890 |
692 |
$142.94 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
143 |
104 |
$124.62 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
100 |
70 |
$110.09 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
124 |
95 |
$103.30 |
| A5120 |
Skin barrier, wipes or swabs, each |
383 |
286 |
$66.62 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
568 |
452 |
$42.92 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
16 |
12 |
$40.50 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
16 |
12 |
$24.04 |
| A4456 |
Adhesive remover, wipes, any type, each |
178 |
123 |
$23.35 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
192 |
157 |
$6.96 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
18 |
12 |
$2.90 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
20 |
15 |
$0.00 |