| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
2,976 |
2,796 |
$134K |
| A6010 |
Collagen based wound filler |
1,094 |
1,023 |
$134K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,095 |
992 |
$114K |
| A6212 |
Foam drg <=16 sq in w/border |
1,227 |
1,144 |
$25K |
| A4623 |
Tracheostomy inner cannula |
903 |
746 |
$21K |
| A6203 |
Composite drsg <= 16 sq in |
1,610 |
1,509 |
$20K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,046 |
957 |
$18K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,241 |
2,112 |
$16K |
| A4452 |
Waterproof tape |
1,856 |
1,725 |
$14K |
| A6021 |
Collagen dressing <=16 sq in |
267 |
251 |
$11K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
398 |
365 |
$10K |
| A4314 |
Cath w/drainage 2-way latex |
2,281 |
2,092 |
$8K |
| A4333 |
Urinary cath anchor device |
2,032 |
1,859 |
$7K |
| A4357 |
Bedside drainage bag |
3,937 |
3,582 |
$7K |
| A4629 |
Tracheostomy care kit |
907 |
748 |
$7K |
| A6199 |
Alginate drsg wound filler |
95 |
92 |
$5K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
713 |
686 |
$4K |
| A7526 |
Tracheostomy tube collar |
790 |
665 |
$3K |
| A6449 |
Lt compres band >=3" <5"/yd |
138 |
116 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
734 |
667 |
$3K |
| A4334 |
Urinary cath leg strap |
1,887 |
1,742 |
$1K |
| A6219 |
Gauze <= 16 sq in w/border |
436 |
423 |
$1K |
| A4315 |
Cath w/drainage 2-way silcne |
407 |
380 |
$1K |
| A6248 |
Hydrogel drsg gel filler |
210 |
195 |
$903.11 |
| A7521 |
Trach/laryn tube cuffed |
233 |
173 |
$688.06 |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
27 |
26 |
$299.98 |
| A5120 |
Skin barrier, wipe or swab |
472 |
443 |
$288.96 |
| A6402 |
Sterile gauze <= 16 sq in |
247 |
215 |
$207.48 |
| A4450 |
Non-waterproof tape |
84 |
82 |
$87.82 |
| A4456 |
Adhesive remover, wipes |
105 |
99 |
$38.64 |
| A4406 |
Pectin based ostomy paste |
12 |
12 |
$32.16 |
| A4626 |
Tracheostomy cleaning brush |
129 |
89 |
$30.96 |
| A4338 |
Indwelling catheter latex |
12 |
12 |
$0.00 |