| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
29,833 |
26,776 |
$7.24M |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
53,737 |
50,506 |
$6.34M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
52,735 |
48,100 |
$4.80M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
47,426 |
43,468 |
$4.01M |
| A4554 |
Disposable underpads, all sizes |
122,332 |
113,518 |
$3.36M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
37,355 |
34,398 |
$3.34M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
65,760 |
61,007 |
$3.33M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
26,629 |
24,319 |
$2.88M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
12,182 |
10,335 |
$2.58M |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
4,402 |
3,684 |
$2.38M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
10,319 |
9,044 |
$1.71M |
| A4927 |
Gloves, non-sterile, per 100 |
136,516 |
126,594 |
$1.65M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
15,529 |
14,445 |
$1.46M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14,436 |
12,663 |
$1.43M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14,439 |
12,437 |
$1.29M |
| A4259 |
Lancets, per box of 100 |
49,856 |
47,067 |
$1.14M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,226 |
4,655 |
$1.07M |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
8,645 |
7,981 |
$810K |
| 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 |
5,716 |
4,847 |
$809K |
| B4100 |
Food thickener, administered orally, per ounce |
5,397 |
4,701 |
$764K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
5,792 |
4,946 |
$687K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,615 |
5,693 |
$627K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,262 |
4,783 |
$534K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
6,722 |
5,855 |
$451K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,028 |
5,560 |
$432K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
5,206 |
4,588 |
$337K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,858 |
1,543 |
$309K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,187 |
2,776 |
$265K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
674 |
498 |
$255K |
| E0607 |
Home blood glucose monitor |
3,756 |
3,177 |
$238K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,377 |
4,764 |
$225K |
| 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 |
1,940 |
1,505 |
$225K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
1,145 |
1,037 |
$213K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,239 |
2,044 |
$209K |
| E0246 |
Transfer tub rail attachment |
2,645 |
2,097 |
$199K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
396 |
364 |
$136K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,639 |
1,542 |
$133K |
| B9998 |
Noc for enteral supplies |
3,376 |
2,705 |
$124K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
477 |
396 |
$107K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,716 |
2,295 |
$105K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,791 |
1,063 |
$104K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
4,833 |
1,025 |
$98K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,425 |
1,943 |
$90K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
2,379 |
1,816 |
$90K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,276 |
1,099 |
$89K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
6,120 |
4,907 |
$74K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,198 |
915 |
$64K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,836 |
2,531 |
$54K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,455 |
1,253 |
$54K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
2,815 |
2,498 |
$50K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
562 |
436 |
$49K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,716 |
2,384 |
$46K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
313 |
124 |
$45K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,952 |
1,571 |
$39K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,160 |
1,878 |
$38K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,423 |
4,585 |
$36K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,991 |
1,650 |
$33K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
303 |
252 |
$32K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,028 |
3,287 |
$31K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
937 |
845 |
$30K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
157 |
144 |
$29K |
| E0241 |
Bath tub wall rail, each |
927 |
712 |
$27K |
| A4402 |
Lubricant, per ounce |
2,479 |
2,106 |
$27K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,088 |
2,492 |
$26K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
88 |
65 |
$25K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
289 |
238 |
$22K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,807 |
2,415 |
$20K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
3,576 |
3,070 |
$20K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
179 |
156 |
$19K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
42 |
42 |
$15K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
788 |
575 |
$15K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
71 |
56 |
$14K |
| 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 |
116 |
102 |
$12K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
196 |
173 |
$9K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,244 |
316 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
344 |
181 |
$8K |
| 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 |
30 |
24 |
$8K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
246 |
184 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
1,228 |
1,082 |
$6K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,376 |
1,125 |
$5K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
82 |
76 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
129 |
122 |
$4K |
| E0244 |
Raised toilet seat |
206 |
169 |
$4K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
669 |
529 |
$3K |
| E0156 |
Seat attachment, walker |
222 |
167 |
$2K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
55 |
49 |
$2K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
148 |
12 |
$2K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
14 |
14 |
$1K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
315 |
271 |
$1K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
48 |
40 |
$652.14 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
16 |
12 |
$308.84 |
| A4367 |
Ostomy belt, each |
25 |
24 |
$118.19 |