| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
1,705 |
1,509 |
$237K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,156 |
1,056 |
$214K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,385 |
2,245 |
$151K |
| T4523 |
Adult size brief/diaper lg |
1,088 |
884 |
$127K |
| T4541 |
Large disposable underpad |
1,972 |
1,633 |
$89K |
| T4527 |
Adult size pull-on lg |
680 |
589 |
$66K |
| A4927 |
Non-sterile gloves |
4,110 |
3,555 |
$64K |
| A4452 |
Waterproof tape |
3,293 |
3,043 |
$61K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,015 |
1,843 |
$53K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,849 |
4,675 |
$36K |
| A4217 |
Sterile water/saline, 500 ml |
4,084 |
3,749 |
$33K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
788 |
706 |
$32K |
| T4535 |
Disposable liner/shield/pad |
616 |
586 |
$31K |
| T4522 |
Adult size brief/diaper med |
291 |
269 |
$30K |
| T4526 |
Adult size pull-on med |
217 |
209 |
$30K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,935 |
1,507 |
$29K |
| T4524 |
Adult size brief/diaper xl |
201 |
191 |
$29K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
165 |
138 |
$24K |
| K0001 |
Standard wheelchair |
4,134 |
3,731 |
$22K |
| A6196 |
Alginate dressing <=16 sq in |
240 |
224 |
$19K |
| A6402 |
Sterile gauze <= 16 sq in |
1,699 |
1,516 |
$12K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
695 |
653 |
$10K |
| E0143 |
Walker folding wheeled w/o s |
794 |
563 |
$9K |
| K0195 |
Elevating whlchair leg rests |
2,108 |
1,870 |
$8K |
| A4450 |
Non-waterproof tape |
1,271 |
1,204 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
605 |
586 |
$6K |
| E0570 |
Nebulizer with compression |
1,234 |
1,105 |
$4K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
55 |
51 |
$3K |
| T4537 |
Reusable underpad bed size |
169 |
167 |
$3K |
| E1038 |
Transport chair pt wt<=300lb |
966 |
839 |
$3K |
| A4362 |
Solid skin barrier |
35 |
29 |
$2K |
| A4385 |
Ost skn barrier sld ext wear |
14 |
12 |
$1K |
| A4424 |
Ost pch drain w bar & filter |
14 |
14 |
$969.60 |
| A6240 |
Hydrocolld drg filler paste |
13 |
13 |
$956.80 |
| A4218 |
Sterile saline or water |
68 |
66 |
$716.00 |
| A4216 |
Sterile water/saline, 10 ml |
134 |
130 |
$614.46 |
| A4425 |
Ost pch drain for barrier fl |
13 |
12 |
$577.60 |
| E0163 |
Commode chair with fixed arm |
33 |
24 |
$499.36 |
| A4369 |
Skin barrier liquid per oz |
41 |
36 |
$259.56 |
| A4456 |
Adhesive remover, wipes |
12 |
12 |
$125.40 |
| E0305 |
Rails bed side half length |
191 |
187 |
$0.00 |
| A4520 |
Incontinence garment anytype |
20 |
16 |
$0.00 |
| E0272 |
Mattress foam rubber |
200 |
197 |
$0.00 |