| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
1,323 |
1,229 |
$363K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
419 |
395 |
$184K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
943 |
861 |
$155K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
630 |
567 |
$114K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
175 |
152 |
$82K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,588 |
1,508 |
$46K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
259 |
243 |
$43K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
871 |
792 |
$36K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
204 |
170 |
$36K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
518 |
471 |
$30K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
605 |
552 |
$26K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
317 |
222 |
$25K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
104 |
67 |
$10K |
| L3260 |
Surgical boot/shoe, each |
162 |
145 |
$8K |
| E0784 |
External ambulatory infusion pump, insulin |
16 |
12 |
$7K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
496 |
322 |
$7K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
230 |
199 |
$5K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
160 |
136 |
$3K |
| 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 |
44 |
41 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
602 |
368 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,285 |
807 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
338 |
278 |
$1K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
15 |
14 |
$993.42 |
| A4456 |
Adhesive remover, wipes, any type, each |
718 |
430 |
$749.26 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
14 |
14 |
$730.33 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
46 |
28 |
$602.80 |
| A4452 |
Tape, waterproof, per 18 square inches |
65 |
53 |
$320.08 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
20 |
14 |
$186.02 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
24 |
12 |
$143.63 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
38 |
24 |
$123.15 |
| A4371 |
Ostomy skin barrier, powder, per oz |
171 |
114 |
$107.99 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
23 |
13 |
$104.08 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12 |
12 |
$102.58 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
71 |
40 |
$62.75 |
| A4927 |
Gloves, non-sterile, per 100 |
19 |
15 |
$15.56 |
| A4367 |
Ostomy belt, each |
18 |
12 |
$5.68 |
| L3674 |
Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
176 |
117 |
$0.00 |
| L3675 |
Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf |
68 |
28 |
$0.00 |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
865 |
563 |
$0.00 |