| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
22,049 |
20,867 |
$1.40M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,213 |
4,965 |
$1.09M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,896 |
9,233 |
$773K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,326 |
4,050 |
$731K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,206 |
2,986 |
$606K |
| A4927 |
Gloves, non-sterile, per 100 |
23,204 |
21,884 |
$510K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,316 |
4,017 |
$468K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
915 |
897 |
$203K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
645 |
630 |
$194K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,015 |
939 |
$160K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,092 |
983 |
$157K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
15,819 |
14,860 |
$144K |
| 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 |
699 |
685 |
$124K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,328 |
2,018 |
$121K |
| 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 |
150 |
146 |
$99K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
531 |
508 |
$74K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
281 |
279 |
$69K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
511 |
471 |
$64K |
| T5999 |
Supply, not otherwise specified |
945 |
830 |
$62K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
160 |
151 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,120 |
1,008 |
$40K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,642 |
1,502 |
$34K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,864 |
1,769 |
$30K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
385 |
369 |
$28K |
| A6260 |
Wound cleansers, any type, any size |
874 |
867 |
$27K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
753 |
687 |
$27K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,276 |
3,163 |
$24K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,275 |
1,250 |
$23K |
| A4217 |
Sterile water/saline, 500 ml |
2,690 |
2,168 |
$22K |
| K0001 |
Standard wheelchair |
830 |
737 |
$18K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,919 |
1,878 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,382 |
1,088 |
$15K |
| A4245 |
Alcohol wipes, per box |
1,479 |
1,448 |
$14K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,480 |
2,413 |
$14K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,010 |
1,975 |
$11K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,083 |
2,034 |
$9K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
37 |
36 |
$8K |
| A5120 |
Skin barrier, wipes or swabs, each |
722 |
674 |
$6K |
| A4500 |
Surgical stockings below knee length, each |
288 |
281 |
$6K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
152 |
149 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
859 |
794 |
$5K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
92 |
87 |
$5K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
1,060 |
1,035 |
$5K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
150 |
147 |
$4K |
| A4402 |
Lubricant, per ounce |
1,459 |
1,424 |
$4K |
| A4670 |
Automatic blood pressure monitor |
56 |
26 |
$2K |
| E0325 |
Urinal; male, jug-type, any material |
739 |
691 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
14 |
14 |
$2K |
| E0570 |
Nebulizer, with compressor |
72 |
59 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
95 |
85 |
$2K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
316 |
253 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
335 |
319 |
$522.07 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
85 |
65 |
$0.00 |