| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Disposable sensor, cgm sys |
4,010 |
3,829 |
$2.06M |
| T4527 |
Adult size pull-on lg |
9,566 |
9,049 |
$1.21M |
| T4526 |
Adult size pull-on med |
8,933 |
8,510 |
$1.14M |
| T4528 |
Adult size pull-on xl |
8,969 |
8,506 |
$1.10M |
| A4927 |
Non-sterile gloves |
36,654 |
34,773 |
$964K |
| T4535 |
Disposable liner/shield/pad |
15,069 |
14,297 |
$769K |
| A4554 |
Disposable underpads |
16,042 |
15,497 |
$642K |
| T4523 |
Adult size brief/diaper lg |
4,202 |
3,962 |
$518K |
| T4541 |
Large disposable underpad |
13,446 |
12,448 |
$510K |
| B4035 |
Enteral feed supp pump per d |
15,554 |
10,793 |
$457K |
| A4239 |
Non-adju cgm supply allow |
2,888 |
2,664 |
$398K |
| T4522 |
Adult size brief/diaper med |
3,746 |
3,541 |
$337K |
| A9277 |
External transmitter, cgm |
1,265 |
1,180 |
$282K |
| T4524 |
Adult size brief/diaper xl |
2,027 |
1,910 |
$276K |
| A4351 |
Straight tip urine catheter |
1,861 |
1,675 |
$274K |
| T4534 |
Youth size pull-on |
2,440 |
2,271 |
$255K |
| B4152 |
Ef calorie dense>/=1.5kcal |
9,735 |
7,549 |
$248K |
| E0603 |
Electric breast pump |
2,412 |
2,306 |
$230K |
| A6530 |
Compression stocking bk18-30 |
1,418 |
1,286 |
$197K |
| T4525 |
Adult size pull-on sm |
1,422 |
1,366 |
$168K |
| A4670 |
Automatic bp monitor, dial |
3,575 |
3,417 |
$158K |
| A4553 |
Nondisp underpads, all sizes |
11,182 |
10,475 |
$158K |
| B4154 |
Ef spec metabolic noninherit |
6,152 |
4,178 |
$151K |
| T4543 |
Adult disp brief/diap abv xl |
668 |
640 |
$150K |
| B4150 |
Ef complet w/intact nutrient |
2,878 |
2,198 |
$141K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,200 |
1,030 |
$138K |
| A4623 |
Tracheostomy inner cannula |
4,454 |
3,792 |
$95K |
| B4034 |
Enter feed supkit syr by day |
3,490 |
2,919 |
$92K |
| E0570 |
Nebulizer with compression |
6,764 |
6,114 |
$86K |
| A7526 |
Tracheostomy tube collar |
4,818 |
4,114 |
$81K |
| B9002 |
Enter nutr inf pump any type |
4,426 |
3,951 |
$69K |
| A5061 |
Pouch drainable w barrier at |
1,481 |
1,313 |
$54K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,627 |
1,477 |
$50K |
| A4253 |
Blood glucose/reagent strips |
5,980 |
5,438 |
$45K |
| K0553 |
Ther cgm supply allowance |
991 |
802 |
$37K |
| A4238 |
Adju cgm supply allowance |
323 |
160 |
$35K |
| T4530 |
Ped size brief/diaper lg |
466 |
412 |
$30K |
| T4521 |
Adult size brief/diaper sm |
322 |
305 |
$30K |
| A6196 |
Alginate dressing <=16 sq in |
981 |
834 |
$30K |
| T4537 |
Reusable underpad bed size |
2,439 |
2,093 |
$26K |
| A6219 |
Gauze <= 16 sq in w/border |
996 |
856 |
$25K |
| A4629 |
Tracheostomy care kit |
1,663 |
1,366 |
$25K |
| A4409 |
Ost skn barr convex <=4 sq i |
386 |
347 |
$25K |
| B4036 |
Enteral feed sup kit grav by |
800 |
419 |
$25K |
| Q0511 |
Sup fee antiem,antica,immuno |
854 |
744 |
$25K |
| K0001 |
Standard wheelchair |
1,461 |
1,372 |
$23K |
| A4357 |
Bedside drainage bag |
2,192 |
1,954 |
$23K |
| A4394 |
Ostomy pouch liq deodorant |
855 |
782 |
$21K |
| A5120 |
Skin barrier, wipe or swab |
1,953 |
1,784 |
$21K |
| B9998 |
Enteral supp not otherwise c |
376 |
304 |
$19K |
| A4425 |
Ost pch drain for barrier fl |
372 |
347 |
$16K |
| L3908 |
Who cock-up nonmolde pre ots |
298 |
258 |
$15K |
| A4456 |
Adhesive remover, wipes |
1,261 |
1,156 |
$15K |
| A4259 |
Lancets per box |
4,761 |
4,392 |
$14K |
| A7521 |
Trach/laryn tube cuffed |
927 |
856 |
$14K |
| A4520 |
Incontinence garment anytype |
172 |
166 |
$13K |
| E0143 |
Walker folding wheeled w/o s |
787 |
712 |
$12K |
| Q0512 |
Px sup fee anti-can sub pres |
600 |
310 |
$12K |
| A5500 |
Diab shoe for density insert |
315 |
194 |
$12K |
| B4088 |
Gastro/jejuno tube, low-pro |
181 |
170 |
$10K |
| A9278 |
External receiver, cgm sys |
29 |
28 |
$10K |
| A4256 |
Calibrator solution/chips |
1,993 |
1,833 |
$9K |
| Q0513 |
Disp fee inhal drugs/30 days |
645 |
589 |
$7K |
| E0118 |
Crutch substitute |
665 |
631 |
$7K |
| A4245 |
Alcohol wipes per box |
1,633 |
1,439 |
$6K |
| A5063 |
Drain ostomy pouch w/flange |
123 |
115 |
$6K |
| B4161 |
Ef ped hydrolyzed/amino acid |
14 |
12 |
$5K |
| E0156 |
Walker seat attachment |
584 |
544 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
393 |
331 |
$4K |
| A7003 |
Nebulizer administration set |
2,594 |
2,388 |
$4K |
| K0195 |
Elevating whlchair leg rests |
408 |
375 |
$3K |
| E0240 |
Bath/shower chair |
72 |
67 |
$3K |
| A5512 |
Multi den insert direct form |
84 |
51 |
$3K |
| E0630 |
Patient lift hydraulic |
68 |
62 |
$3K |
| E0100 |
Cane adjust/fixed with tip |
164 |
155 |
$2K |
| A4362 |
Solid skin barrier |
94 |
85 |
$2K |
| A4406 |
Pectin based ostomy paste |
179 |
159 |
$2K |
| A4385 |
Ost skn barrier sld ext wear |
27 |
24 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,682 |
1,564 |
$2K |
| E0303 |
Hosp bed hvy dty xtra wide |
12 |
12 |
$2K |
| B4087 |
Gastro/jejuno tube, std |
69 |
60 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
191 |
166 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
48 |
48 |
$2K |
| A4663 |
Dialysis blood pressure cuff |
313 |
290 |
$1K |
| A4407 |
Ext wear ost skn barr <=4sq" |
13 |
12 |
$1K |
| E0149 |
Heavy duty wheeled walker |
147 |
133 |
$1K |
| A4258 |
Lancet device each |
639 |
603 |
$1K |
| L1820 |
Ko elas w/ condyle pads & jo |
20 |
16 |
$1K |
| A7013 |
Disposable compressor filter |
2,273 |
2,131 |
$1K |
| A4338 |
Indwelling catheter latex |
317 |
273 |
$754.86 |
| A4310 |
Insert tray w/o bag/cath |
564 |
519 |
$580.37 |
| A4450 |
Non-waterproof tape |
15 |
13 |
$329.59 |
| A4371 |
Skin barrier powder per oz |
37 |
36 |
$272.19 |
| A7004 |
Disposable nebulizer sml vol |
113 |
107 |
$129.60 |
| J7620 |
Albuterol ipratrop non-comp |
50 |
36 |
$77.10 |
| J7613 |
Albuterol non-comp unit |
145 |
127 |
$57.81 |
| 0124A |
|
111 |
37 |
$0.00 |
| G0008 |
Admin influenza virus vac |
121 |
41 |
$0.00 |
| 90686 |
|
76 |
26 |
$0.00 |
| 90694 |
|
45 |
15 |
$0.00 |
| J7507 |
Tacrolimus imme rel oral 1mg |
18 |
12 |
$0.00 |