| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary catheter, with insertion supplies |
30,886 |
22,681 |
$18.51M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
41,119 |
29,893 |
$3.50M |
| A4554 |
Disposable underpads, all sizes |
85,849 |
60,880 |
$2.70M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
30,119 |
22,611 |
$2.35M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
7,627 |
5,728 |
$2.27M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
24,981 |
19,150 |
$2.21M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
16,888 |
12,321 |
$1.50M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
16,057 |
11,351 |
$1.39M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
15,719 |
11,928 |
$1.37M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,403 |
8,229 |
$1.13M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,056 |
7,496 |
$931K |
| A4927 |
Gloves, non-sterile, per 100 |
64,616 |
49,540 |
$854K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
9,420 |
6,218 |
$764K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
5,088 |
3,911 |
$671K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
16,534 |
16,107 |
$637K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
10,185 |
6,604 |
$599K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
18,336 |
13,352 |
$575K |
| 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 |
2,283 |
1,194 |
$484K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,972 |
1,995 |
$456K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
5,873 |
3,751 |
$424K |
| T4541 |
Incontinence product, disposable underpad, large, each |
18,576 |
17,657 |
$423K |
| 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 |
6,137 |
3,836 |
$413K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
4,504 |
3,495 |
$388K |
| 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 |
1,398 |
820 |
$344K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,915 |
1,600 |
$320K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,506 |
2,696 |
$318K |
| 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 |
4,670 |
3,165 |
$306K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
3,029 |
2,144 |
$253K |
| 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 |
1,943 |
1,258 |
$166K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
5,316 |
3,703 |
$126K |
| 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 |
1,442 |
988 |
$117K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,732 |
732 |
$97K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
11,572 |
8,302 |
$94K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,741 |
1,554 |
$84K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
3,246 |
2,350 |
$81K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
4,663 |
3,432 |
$72K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,260 |
766 |
$68K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,135 |
999 |
$62K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,304 |
1,111 |
$55K |
| A4217 |
Sterile water/saline, 500 ml |
2,362 |
1,775 |
$54K |
| A4335 |
Incontinence supply; miscellaneous |
4,445 |
3,732 |
$53K |
| A4400 |
Ostomy irrigation set |
1,442 |
965 |
$50K |
| W0137 |
|
975 |
928 |
$45K |
| A4332 |
Lubricant, individual sterile packet, each |
7,478 |
6,216 |
$44K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
8,340 |
6,111 |
$41K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,151 |
1,025 |
$40K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
494 |
445 |
$37K |
| B4100 |
Food thickener, administered orally, per ounce |
631 |
359 |
$36K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,255 |
1,083 |
$34K |
| A4553 |
Non-disposable underpads, all sizes |
1,690 |
1,625 |
$34K |
| T5999 |
Supply, not otherwise specified |
3,802 |
3,732 |
$33K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
393 |
234 |
$30K |
| A4402 |
Lubricant, per ounce |
7,824 |
5,996 |
$25K |
| X1939 |
|
400 |
399 |
$22K |
| 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 |
271 |
192 |
$18K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
720 |
620 |
$17K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,332 |
3,428 |
$17K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
465 |
348 |
$13K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,954 |
1,418 |
$13K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,036 |
2,681 |
$12K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,065 |
900 |
$11K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
266 |
234 |
$11K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,635 |
2,446 |
$10K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,094 |
721 |
$8K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
102 |
69 |
$8K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
807 |
685 |
$7K |
| A4399 |
Ostomy irrigation supply; cone/catheter, with or without brush |
689 |
581 |
$6K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,182 |
896 |
$6K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,461 |
1,244 |
$5K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
319 |
271 |
$4K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
158 |
121 |
$2K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
61 |
58 |
$2K |
| B9998 |
Noc for enteral supplies |
159 |
132 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,022 |
608 |
$1K |
| A4367 |
Ostomy belt, each |
451 |
418 |
$1K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
332 |
213 |
$800.08 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
245 |
186 |
$656.96 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
61 |
52 |
$437.00 |
| A4452 |
Tape, waterproof, per 18 square inches |
43 |
37 |
$295.45 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
110 |
93 |
$198.17 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
37 |
36 |
$70.59 |
| A9270 |
Non-covered item or service |
97 |
89 |
$0.00 |