| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,657 |
5,286 |
$1.22M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
4,922 |
4,761 |
$1.03M |
| 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 |
4,370 |
4,004 |
$915K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
4,190 |
3,822 |
$477K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,855 |
3,631 |
$342K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,959 |
2,614 |
$338K |
| E0784 |
External ambulatory infusion pump, insulin |
413 |
390 |
$328K |
| A6210 |
Foam 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 |
1,771 |
1,590 |
$318K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
4,182 |
3,964 |
$296K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
2,405 |
2,208 |
$246K |
| 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 |
4,510 |
4,209 |
$239K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,903 |
1,797 |
$223K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
2,528 |
2,318 |
$220K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
509 |
368 |
$209K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,382 |
1,254 |
$191K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
364 |
349 |
$176K |
| 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 |
1,046 |
970 |
$170K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,493 |
2,301 |
$160K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,678 |
1,548 |
$158K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,112 |
1,990 |
$157K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
5,788 |
5,398 |
$145K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,801 |
2,661 |
$113K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
530 |
508 |
$108K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,832 |
6,426 |
$93K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,033 |
932 |
$91K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
481 |
440 |
$89K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,991 |
2,837 |
$83K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,073 |
1,949 |
$77K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
617 |
566 |
$74K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
2,439 |
2,217 |
$66K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
970 |
921 |
$66K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
893 |
859 |
$59K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,540 |
1,446 |
$58K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
8,440 |
7,739 |
$58K |
| 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 |
1,310 |
1,221 |
$57K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
831 |
786 |
$46K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,476 |
6,129 |
$45K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,047 |
1,926 |
$42K |
| A4456 |
Adhesive remover, wipes, any type, each |
5,040 |
4,807 |
$41K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
704 |
635 |
$41K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,720 |
5,477 |
$36K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
484 |
446 |
$35K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
946 |
889 |
$34K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,000 |
896 |
$33K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
613 |
566 |
$31K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,817 |
1,323 |
$27K |
| A4554 |
Disposable underpads, all sizes |
1,162 |
1,071 |
$25K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,507 |
2,341 |
$25K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
122 |
118 |
$24K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
203 |
190 |
$21K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,408 |
1,313 |
$17K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
249 |
227 |
$17K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,614 |
3,459 |
$16K |
| A4217 |
Sterile water/saline, 500 ml |
2,955 |
2,871 |
$16K |
| A6260 |
Wound cleansers, any type, any size |
1,580 |
1,544 |
$14K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
628 |
587 |
$12K |
| A4927 |
Gloves, non-sterile, per 100 |
1,938 |
1,864 |
$12K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
259 |
250 |
$11K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
483 |
439 |
$10K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,413 |
1,325 |
$10K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,191 |
2,107 |
$10K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
107 |
102 |
$8K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
71 |
67 |
$7K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
98 |
93 |
$7K |
| A4367 |
Ostomy belt, each |
1,382 |
1,301 |
$6K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
875 |
803 |
$6K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
172 |
161 |
$6K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
525 |
509 |
$6K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
383 |
343 |
$5K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,405 |
1,344 |
$5K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
66 |
62 |
$4K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
44 |
39 |
$4K |
| A4259 |
Lancets, per box of 100 |
1,221 |
997 |
$4K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
220 |
206 |
$3K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
479 |
462 |
$3K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
39 |
36 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
121 |
112 |
$2K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
732 |
691 |
$2K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
14 |
12 |
$1K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
13 |
12 |
$1K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
27 |
24 |
$866.71 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
17 |
14 |
$856.82 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
14 |
12 |
$836.08 |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
12 |
12 |
$692.58 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12 |
12 |
$656.57 |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
16 |
13 |
$550.02 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
61 |
48 |
$526.21 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
12 |
12 |
$474.66 |
| A4335 |
Incontinence supply; miscellaneous |
127 |
98 |
$472.85 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
51 |
44 |
$253.18 |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
15 |
12 |
$227.98 |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
17 |
14 |
$198.44 |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
14 |
12 |
$129.78 |
| A4322 |
Irrigation syringe, bulb or piston, each |
15 |
13 |
$62.03 |
| A4245 |
Alcohol wipes, per box |
36 |
26 |
$43.50 |
| T4541 |
Incontinence product, disposable underpad, large, each |
28 |
24 |
$0.00 |