| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
123,618 |
104,479 |
$6.33M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
44,896 |
37,817 |
$5.15M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
37,543 |
31,312 |
$4.81M |
| 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 |
19,653 |
12,254 |
$4.74M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
64,920 |
51,961 |
$3.01M |
| 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 |
4,241 |
3,325 |
$3.01M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
16,731 |
15,988 |
$2.90M |
| A4927 |
Gloves, non-sterile, per 100 |
176,952 |
116,797 |
$2.54M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
20,030 |
16,801 |
$2.47M |
| 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 |
40,251 |
17,751 |
$2.01M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
18,113 |
15,929 |
$2.00M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,835 |
7,098 |
$1.92M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
15,366 |
14,095 |
$1.60M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12,632 |
10,888 |
$1.53M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
8,997 |
8,109 |
$1.19M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
6,594 |
5,462 |
$1.18M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
10,111 |
8,663 |
$1.14M |
| 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 |
10,049 |
4,432 |
$1.09M |
| 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 |
3,185 |
2,036 |
$1.02M |
| 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 |
12,103 |
5,950 |
$965K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
9,994 |
9,488 |
$882K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
7,453 |
6,281 |
$861K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
10,324 |
6,945 |
$817K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
6,419 |
3,923 |
$799K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
9,635 |
8,485 |
$786K |
| 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 |
1,564 |
1,326 |
$596K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
109,312 |
72,311 |
$594K |
| B9998 |
Noc for enteral supplies |
13,295 |
8,582 |
$580K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
7,865 |
7,373 |
$571K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,594 |
2,435 |
$488K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,975 |
3,658 |
$459K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
1,720 |
1,139 |
$403K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,019 |
2,824 |
$305K |
| 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 |
405 |
340 |
$294K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,127 |
772 |
$281K |
| A4553 |
Non-disposable underpads, all sizes |
14,849 |
10,883 |
$254K |
| 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 |
1,513 |
1,155 |
$254K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
1,115 |
984 |
$226K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
971 |
861 |
$200K |
| 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 |
3,361 |
2,469 |
$155K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,712 |
1,475 |
$153K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
3,026 |
2,828 |
$126K |
| A4456 |
Adhesive remover, wipes, any type, each |
9,009 |
8,236 |
$126K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
9,779 |
9,355 |
$125K |
| B9002 |
Enteral nutrition infusion pump, any type |
160 |
150 |
$124K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
4,670 |
3,314 |
$122K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
6,362 |
5,816 |
$120K |
| A6210 |
Foam 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 |
763 |
504 |
$120K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,767 |
1,396 |
$117K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
946 |
806 |
$113K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
8,976 |
8,111 |
$112K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,475 |
2,113 |
$112K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,496 |
1,072 |
$94K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,702 |
1,199 |
$89K |
| A4452 |
Tape, waterproof, per 18 square inches |
5,756 |
4,715 |
$88K |
| B4100 |
Food thickener, administered orally, per ounce |
2,558 |
1,597 |
$83K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
1,312 |
1,241 |
$81K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
2,136 |
1,844 |
$80K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
9,150 |
6,570 |
$78K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,250 |
890 |
$75K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
4,595 |
4,118 |
$75K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
4,253 |
3,862 |
$68K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
409 |
384 |
$65K |
| A5120 |
Skin barrier, wipes or swabs, each |
9,419 |
8,838 |
$64K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
4,176 |
3,750 |
$57K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
596 |
395 |
$57K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,314 |
2,880 |
$55K |
| A6260 |
Wound cleansers, any type, any size |
6,560 |
4,782 |
$48K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
724 |
639 |
$43K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
1,606 |
1,497 |
$37K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,411 |
2,773 |
$32K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
4,608 |
4,204 |
$29K |
| A4402 |
Lubricant, per ounce |
5,926 |
5,502 |
$25K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
221 |
214 |
$25K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
251 |
220 |
$19K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,365 |
1,214 |
$19K |
| A4371 |
Ostomy skin barrier, powder, per oz |
5,178 |
4,827 |
$17K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
84 |
75 |
$15K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
115 |
107 |
$14K |
| A4367 |
Ostomy belt, each |
2,079 |
1,956 |
$14K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
105 |
75 |
$12K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
66 |
64 |
$11K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
1,117 |
789 |
$10K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
455 |
315 |
$10K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
43 |
26 |
$10K |
| B4081 |
Nasogastric tubing with stylet |
128 |
100 |
$9K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
766 |
752 |
$7K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,399 |
1,304 |
$6K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
287 |
265 |
$5K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
2,337 |
2,190 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,863 |
1,218 |
$5K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
43 |
38 |
$4K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
18 |
18 |
$4K |
| A4332 |
Lubricant, individual sterile packet, each |
232 |
204 |
$4K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
63 |
38 |
$4K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
457 |
393 |
$3K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
65 |
39 |
$2K |
| E0776 |
Iv pole |
14 |
13 |
$2K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
13 |
12 |
$646.13 |
| T5999 |
Supply, not otherwise specified |
812 |
692 |
$577.78 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
119 |
102 |
$490.17 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
50 |
39 |
$343.87 |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
29 |
29 |
$156.08 |