| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
445 |
444 |
$55K |
| A6197 |
Alginate drsg >16 <=48 sq in |
171 |
171 |
$31K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
444 |
439 |
$28K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
37 |
37 |
$17K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
93 |
92 |
$13K |
| A6212 |
Foam drg <=16 sq in w/border |
156 |
153 |
$13K |
| A6446 |
Conform band s w>=3" <5"/yd |
944 |
941 |
$10K |
| A6402 |
Sterile gauze <= 16 sq in |
931 |
928 |
$8K |
| L3001 |
Foot insert remov molded spe |
70 |
35 |
$4K |
| A4452 |
Waterproof tape |
662 |
658 |
$3K |
| A6021 |
Collagen dressing <=16 sq in |
27 |
27 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
56 |
56 |
$2K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
12 |
12 |
$1K |
| A4450 |
Non-waterproof tape |
340 |
339 |
$1K |
| A6449 |
Lt compres band >=3" <5"/yd |
234 |
229 |
$591.77 |
| A6266 |
Impreg gauze no h20/sal/yard |
12 |
12 |
$530.40 |
| A6216 |
Non-sterile gauze<=16 sq in |
24 |
24 |
$111.90 |