| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
5,657 |
5,286 |
$1.22M |
| K0553 |
Ther cgm supply allowance |
4,922 |
4,761 |
$1.03M |
| A6197 |
Alginate drsg >16 <=48 sq in |
4,370 |
4,004 |
$915K |
| A6212 |
Foam drg <=16 sq in w/border |
4,190 |
3,822 |
$477K |
| E0603 |
Electric breast pump |
3,855 |
3,631 |
$342K |
| A6021 |
Collagen dressing <=16 sq in |
2,959 |
2,614 |
$338K |
| E0784 |
Ext amb infusn pump insulin |
413 |
390 |
$328K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,771 |
1,590 |
$318K |
| A4385 |
Ost skn barrier sld ext wear |
4,182 |
3,964 |
$296K |
| A6196 |
Alginate dressing <=16 sq in |
2,405 |
2,208 |
$246K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,510 |
4,209 |
$239K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,903 |
1,797 |
$223K |
| A4230 |
Infus insulin pump non needl |
2,528 |
2,318 |
$220K |
| A4353 |
Intermittent urinary cath |
509 |
368 |
$209K |
| A4351 |
Straight tip urine catheter |
1,382 |
1,254 |
$191K |
| A9274 |
Ext amb insulin delivery sys |
364 |
349 |
$176K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,046 |
970 |
$170K |
| A6449 |
Lt compres band >=3" <5"/yd |
2,493 |
2,301 |
$160K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,678 |
1,548 |
$158K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,112 |
1,990 |
$157K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,788 |
5,398 |
$145K |
| A4362 |
Solid skin barrier |
2,801 |
2,661 |
$113K |
| E2103 |
Non-adju cgm receiver/mon |
530 |
508 |
$108K |
| A4452 |
Waterproof tape |
6,832 |
6,426 |
$93K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,033 |
932 |
$91K |
| A6452 |
High compres band w>=3"<5"yd |
481 |
440 |
$89K |
| A4394 |
Ostomy pouch liq deodorant |
2,991 |
2,837 |
$83K |
| A4425 |
Ost pch drain for barrier fl |
2,073 |
1,949 |
$77K |
| A5057 |
1 pc ost pou w built-in conv |
617 |
566 |
$74K |
| A4232 |
Syringe w/needle insulin 3cc |
2,439 |
2,217 |
$66K |
| A5121 |
Solid skin barrier 6x6 |
970 |
921 |
$66K |
| A5056 |
1 pc ost pouch w filter |
893 |
859 |
$59K |
| A5063 |
Drain ostomy pouch w/flange |
1,540 |
1,446 |
$58K |
| A6216 |
Non-sterile gauze<=16 sq in |
8,440 |
7,739 |
$58K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,310 |
1,221 |
$57K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
831 |
786 |
$46K |
| A6402 |
Sterile gauze <= 16 sq in |
6,476 |
6,129 |
$45K |
| A4406 |
Pectin based ostomy paste |
2,047 |
1,926 |
$42K |
| A4456 |
Adhesive remover, wipes |
5,040 |
4,807 |
$41K |
| A4419 |
Ost pch for bar w flange/flt |
704 |
635 |
$41K |
| A5120 |
Skin barrier, wipe or swab |
5,720 |
5,477 |
$36K |
| A5061 |
Pouch drainable w barrier at |
484 |
446 |
$35K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
946 |
889 |
$34K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,000 |
896 |
$33K |
| A6266 |
Impreg gauze no h20/sal/yard |
613 |
566 |
$31K |
| A4253 |
Blood glucose/reagent strips |
1,817 |
1,323 |
$27K |
| A4554 |
Disposable underpads |
1,162 |
1,071 |
$25K |
| A4357 |
Bedside drainage bag |
2,507 |
2,341 |
$25K |
| K0554 |
Ther cgm receiver/monitor |
122 |
118 |
$24K |
| A4410 |
Ost skn barr extnd >4 sq |
203 |
190 |
$21K |
| A4338 |
Indwelling catheter latex |
1,408 |
1,313 |
$17K |
| A4424 |
Ost pch drain w bar & filter |
249 |
227 |
$17K |
| A4450 |
Non-waterproof tape |
3,614 |
3,459 |
$16K |
| A4217 |
Sterile water/saline, 500 ml |
2,955 |
2,871 |
$16K |
| A6260 |
Wound cleanser any type/size |
1,580 |
1,544 |
$14K |
| A6219 |
Gauze <= 16 sq in w/border |
628 |
587 |
$12K |
| A4927 |
Non-sterile gloves |
1,938 |
1,864 |
$12K |
| A6248 |
Hydrogel drsg gel filler |
259 |
250 |
$11K |
| A6441 |
Pad band w>=3" <5"/yd |
483 |
439 |
$10K |
| A4310 |
Insert tray w/o bag/cath |
1,413 |
1,325 |
$10K |
| A4371 |
Skin barrier powder per oz |
2,191 |
2,107 |
$10K |
| A6207 |
Contact layer >16<= 48 sq in |
107 |
102 |
$8K |
| A4389 |
Drainable pch w st wear barr |
71 |
67 |
$7K |
| A4388 |
Drainable pch w ex wear barr |
98 |
93 |
$7K |
| A4367 |
Ostomy belt |
1,382 |
1,301 |
$6K |
| A4358 |
Urinary leg or abdomen bag |
875 |
803 |
$6K |
| A4432 |
Os pch urine w bar/fange/tap |
172 |
161 |
$6K |
| A4216 |
Sterile water/saline, 10 ml |
525 |
509 |
$6K |
| A6457 |
Tubular dressing |
383 |
343 |
$5K |
| A4369 |
Skin barrier liquid per oz |
1,405 |
1,344 |
$5K |
| A6199 |
Alginate drsg wound filler |
66 |
62 |
$4K |
| T4534 |
Youth size pull-on |
44 |
39 |
$4K |
| A4259 |
Lancets per box |
1,221 |
997 |
$4K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
220 |
206 |
$3K |
| A6217 |
Non-sterile gauze>16<=48 sq |
479 |
462 |
$3K |
| A6240 |
Hydrocolld drg filler paste |
39 |
36 |
$3K |
| T4535 |
Disposable liner/shield/pad |
121 |
112 |
$2K |
| A4455 |
Adhesive remover per ounce |
732 |
691 |
$2K |
| A4373 |
Skin barrier with flange |
14 |
12 |
$1K |
| A9276 |
Disposable sensor, cgm sys |
13 |
12 |
$1K |
| A4427 |
Ost pch drain/barr lk flng/f |
27 |
24 |
$866.71 |
| A6258 |
Transparent film >16<=48 in |
17 |
14 |
$856.82 |
| T4528 |
Adult size pull-on xl |
14 |
12 |
$836.08 |
| A6450 |
Lt compres band >=5"/yd |
12 |
12 |
$692.58 |
| T4526 |
Adult size pull-on med |
12 |
12 |
$656.57 |
| A6456 |
Zinc paste band w >=3"<5"/yd |
16 |
13 |
$550.02 |
| A6250 |
Skin seal protect moisturizr |
61 |
48 |
$526.21 |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
12 |
12 |
$474.66 |
| A4335 |
Incontinence supply |
127 |
98 |
$472.85 |
| A4333 |
Urinary cath anchor device |
51 |
44 |
$253.18 |
| A4224 |
Supply insulin inf cath/wk |
15 |
12 |
$227.98 |
| A4320 |
Irrigation tray |
17 |
14 |
$198.44 |
| A4225 |
Sup/ext insulin inf pump syr |
14 |
12 |
$129.78 |
| A4322 |
Irrigation syringe |
15 |
13 |
$62.03 |
| A4245 |
Alcohol wipes per box |
36 |
26 |
$43.50 |
| T4541 |
Large disposable underpad |
28 |
24 |
$0.00 |