| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
27 |
24 |
$150.94 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
111 |
109 |
$37.20 |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
26 |
26 |
$0.00 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
14 |
13 |
$0.00 |