| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
973 |
673 |
$990K |
| A6212 |
Foam drg <=16 sq in w/border |
1,377 |
870 |
$536K |
| T4527 |
Adult size pull-on lg |
2,003 |
1,919 |
$471K |
| A4554 |
Disposable underpads |
6,705 |
6,413 |
$427K |
| T4526 |
Adult size pull-on med |
1,911 |
1,840 |
$377K |
| A6250 |
Skin seal protect moisturizr |
5,554 |
5,047 |
$302K |
| A4927 |
Non-sterile gloves |
9,700 |
8,567 |
$217K |
| A6248 |
Hydrogel drsg gel filler |
473 |
329 |
$195K |
| T4544 |
Adlt disp und/pull on abv xl |
480 |
463 |
$171K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
225 |
149 |
$109K |
| T4528 |
Adult size pull-on xl |
424 |
396 |
$100K |
| A4409 |
Ost skn barr convex <=4 sq i |
488 |
463 |
$90K |
| A4385 |
Ost skn barrier sld ext wear |
296 |
271 |
$81K |
| A6402 |
Sterile gauze <= 16 sq in |
2,032 |
1,493 |
$77K |
| A4425 |
Ost pch drain for barrier fl |
567 |
423 |
$55K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
269 |
146 |
$54K |
| A6260 |
Wound cleanser any type/size |
2,522 |
2,146 |
$48K |
| A6021 |
Collagen dressing <=16 sq in |
49 |
24 |
$29K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
209 |
132 |
$23K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
837 |
590 |
$22K |
| A6219 |
Gauze <= 16 sq in w/border |
89 |
72 |
$22K |
| A5120 |
Skin barrier, wipe or swab |
1,919 |
1,811 |
$17K |
| A4406 |
Pectin based ostomy paste |
415 |
395 |
$14K |
| A4314 |
Cath w/drainage 2-way latex |
477 |
430 |
$10K |
| A4452 |
Waterproof tape |
728 |
518 |
$10K |
| A4371 |
Skin barrier powder per oz |
434 |
407 |
$7K |
| A6441 |
Pad band w>=3" <5"/yd |
111 |
67 |
$7K |
| A4358 |
Urinary leg or abdomen bag |
478 |
439 |
$3K |
| A4455 |
Adhesive remover per ounce |
78 |
73 |
$2K |
| A4331 |
Extension drainage tubing |
374 |
312 |
$1K |
| A4394 |
Ostomy pouch liq deodorant |
86 |
81 |
$1K |
| A4338 |
Indwelling catheter latex |
63 |
60 |
$271.92 |