| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
477 |
462 |
$61K |
| A6449 |
Lt compres band >=3" <5"/yd |
354 |
346 |
$48K |
| A6212 |
Foam drg <=16 sq in w/border |
231 |
216 |
$15K |
| A6021 |
Collagen dressing <=16 sq in |
90 |
88 |
$14K |
| A6402 |
Sterile gauze <= 16 sq in |
1,256 |
1,200 |
$7K |
| A6446 |
Conform band s w>=3" <5"/yd |
245 |
239 |
$5K |
| A6197 |
Alginate drsg >16 <=48 sq in |
25 |
24 |
$5K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
59 |
57 |
$4K |
| A4452 |
Waterproof tape |
457 |
413 |
$3K |
| A4450 |
Non-waterproof tape |
681 |
561 |
$3K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
75 |
74 |
$2K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
77 |
72 |
$2K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
32 |
32 |
$1K |
| A4927 |
Non-sterile gloves |
60 |
58 |
$701.90 |
| A6219 |
Gauze <= 16 sq in w/border |
49 |
47 |
$316.01 |
| A6457 |
Tubular dressing |
47 |
47 |
$117.98 |