| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
5,120 |
5,118 |
$268K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,016 |
2,016 |
$145K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,253 |
1,253 |
$141K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
578 |
578 |
$101K |
| 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 |
178 |
178 |
$97K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
176 |
169 |
$63K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,126 |
1,120 |
$47K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,807 |
1,793 |
$46K |
| A4217 |
Sterile water/saline, 500 ml |
523 |
511 |
$37K |
| 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 |
201 |
201 |
$29K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
477 |
477 |
$27K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
84 |
84 |
$15K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
178 |
178 |
$13K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
258 |
258 |
$11K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
114 |
114 |
$11K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
442 |
439 |
$11K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
402 |
322 |
$9K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
410 |
403 |
$7K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
54 |
41 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
269 |
269 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
395 |
393 |
$3K |
| A4456 |
Adhesive remover, wipes, any type, each |
342 |
342 |
$3K |
| A6404 |
Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
41 |
41 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
53 |
41 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
27 |
26 |
$1K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
28 |
27 |
$721.60 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
55 |
55 |
$602.50 |