| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
10,862 |
9,965 |
$129K |
| A6010 |
Collagen based wound filler |
2,965 |
2,626 |
$125K |
| A6197 |
Alginate drsg >16 <=48 sq in |
3,664 |
3,301 |
$121K |
| A4452 |
Waterproof tape |
7,163 |
6,517 |
$70K |
| A6203 |
Composite drsg <= 16 sq in |
4,617 |
4,258 |
$46K |
| A6212 |
Foam drg <=16 sq in w/border |
4,211 |
3,871 |
$46K |
| A6021 |
Collagen dressing <=16 sq in |
1,870 |
1,714 |
$34K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,443 |
4,055 |
$17K |
| A6199 |
Alginate drsg wound filler |
906 |
790 |
$16K |
| A4623 |
Tracheostomy inner cannula |
1,367 |
1,236 |
$16K |
| A6446 |
Conform band s w>=3" <5"/yd |
7,283 |
6,594 |
$13K |
| A4314 |
Cath w/drainage 2-way latex |
6,696 |
5,945 |
$11K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,761 |
1,564 |
$10K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
790 |
719 |
$10K |
| A4333 |
Urinary cath anchor device |
5,664 |
5,089 |
$9K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
2,340 |
2,165 |
$9K |
| A4394 |
Ostomy pouch liq deodorant |
1,355 |
1,226 |
$9K |
| A6248 |
Hydrogel drsg gel filler |
1,671 |
1,476 |
$9K |
| A6449 |
Lt compres band >=3" <5"/yd |
842 |
752 |
$8K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
706 |
640 |
$8K |
| A4357 |
Bedside drainage bag |
11,507 |
10,227 |
$7K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
619 |
574 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
2,018 |
1,881 |
$6K |
| A4315 |
Cath w/drainage 2-way silcne |
2,835 |
2,552 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
3,447 |
3,068 |
$5K |
| A4629 |
Tracheostomy care kit |
675 |
622 |
$5K |
| A4334 |
Urinary cath leg strap |
5,980 |
5,283 |
$4K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
240 |
209 |
$4K |
| A4320 |
Irrigation tray |
666 |
600 |
$3K |
| A4456 |
Adhesive remover, wipes |
2,521 |
2,247 |
$3K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
470 |
427 |
$3K |
| A5063 |
Drain ostomy pouch w/flange |
1,517 |
1,388 |
$3K |
| A6219 |
Gauze <= 16 sq in w/border |
782 |
735 |
$3K |
| A7526 |
Tracheostomy tube collar |
1,497 |
1,388 |
$3K |
| A5131 |
Appliance cleaner |
346 |
321 |
$3K |
| A6231 |
Hydrogel dsg<=16 sq in |
101 |
94 |
$2K |
| A4406 |
Pectin based ostomy paste |
234 |
215 |
$2K |
| A4425 |
Ost pch drain for barrier fl |
458 |
388 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
3,580 |
3,118 |
$1K |
| A5061 |
Pouch drainable w barrier at |
318 |
290 |
$1K |
| A4409 |
Ost skn barr convex <=4 sq i |
503 |
442 |
$879.69 |
| A4450 |
Non-waterproof tape |
1,099 |
1,013 |
$814.93 |
| A4354 |
Cath insertion tray w/bag |
672 |
601 |
$762.40 |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
147 |
141 |
$749.74 |
| A4340 |
Indwelling catheter special |
429 |
369 |
$732.07 |
| A6240 |
Hydrocolld drg filler paste |
137 |
128 |
$721.56 |
| A6454 |
Self-adher band w>=3" <5"/yd |
133 |
118 |
$529.35 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
233 |
212 |
$438.21 |
| A6245 |
Hydrogel drg <= 16 in w/bdr |
13 |
12 |
$335.15 |
| A4371 |
Skin barrier powder per oz |
96 |
90 |
$332.93 |
| A6257 |
Transparent film <= 16 sq in |
36 |
31 |
$163.26 |
| A4407 |
Ext wear ost skn barr <=4sq" |
66 |
62 |
$153.20 |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
12 |
12 |
$145.80 |
| A6266 |
Impreg gauze no h20/sal/yard |
161 |
143 |
$57.87 |
| A7521 |
Trach/laryn tube cuffed |
78 |
69 |
$28.18 |
| A4338 |
Indwelling catheter latex |
36 |
26 |
$16.22 |
| A4344 |
Cath indw foley 2 way silicn |
34 |
30 |
$9.50 |
| A4310 |
Insert tray w/o bag/cath |
13 |
12 |
$4.40 |
| A4311 |
Catheter w/o bag 2-way latex |
29 |
28 |
$4.16 |