| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
953 |
799 |
$27K |
| A6021 |
Collagen dressing <=16 sq in |
356 |
324 |
$27K |
| A6212 |
Foam drg <=16 sq in w/border |
626 |
544 |
$12K |
| A6197 |
Alginate drsg >16 <=48 sq in |
150 |
124 |
$12K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
591 |
539 |
$9K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,127 |
1,000 |
$7K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
402 |
347 |
$6K |
| A6583 |
Grad com wrap w straps bk |
146 |
74 |
$5K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
277 |
240 |
$3K |
| A4452 |
Waterproof tape |
597 |
544 |
$3K |
| A4450 |
Non-waterproof tape |
1,164 |
1,037 |
$2K |
| A6585 |
Grad com wrap w straps ak |
26 |
13 |
$2K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
36 |
33 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
661 |
609 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
1,256 |
1,139 |
$902.79 |
| A6210 |
Foam drg >16<=48 sq in w/o b |
12 |
12 |
$839.33 |
| A6219 |
Gauze <= 16 sq in w/border |
132 |
118 |
$659.54 |
| A6449 |
Lt compres band >=3" <5"/yd |
43 |
40 |
$520.35 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
15 |
14 |
$325.19 |
| A6454 |
Self-adher band w>=3" <5"/yd |
43 |
38 |
$323.97 |
| A6240 |
Hydrocolld drg filler paste |
12 |
12 |
$241.01 |
| A6457 |
Tubular dressing |
70 |
65 |
$166.32 |
| A6266 |
Impreg gauze no h20/sal/yard |
20 |
13 |
$94.54 |
| A6216 |
Non-sterile gauze<=16 sq in |
256 |
215 |
$55.70 |
| A6594 |
G comp bandge liner lwr extr |
24 |
12 |
$53.04 |