| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item, nos, each |
918 |
814 |
$142K |
| E1399 |
Durable medical equipment, miscellaneous |
1,386 |
435 |
$84K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
680 |
347 |
$55K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
38 |
36 |
$27K |
| A4927 |
Gloves, non-sterile, per 100 |
598 |
537 |
$21K |
| A4554 |
Disposable underpads, all sizes |
494 |
405 |
$16K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
525 |
453 |
$12K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
100 |
97 |
$9K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
91 |
88 |
$6K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
148 |
145 |
$6K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$6K |
| A4371 |
Ostomy skin barrier, powder, per oz |
116 |
110 |
$6K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
31 |
28 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
335 |
308 |
$4K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
55 |
51 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
334 |
310 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
57 |
52 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
79 |
75 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
26 |
25 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
108 |
105 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
408 |
318 |
$1K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
69 |
65 |
$699.22 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
354 |
243 |
$405.52 |
| 0013A |
|
18 |
14 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
16 |
12 |
$0.00 |
| 90686 |
|
16 |
12 |
$0.00 |