| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11043 |
|
116,888 |
44,446 |
$3.52M |
| 99308 |
|
201,003 |
100,464 |
$2.80M |
| 99309 |
|
109,537 |
64,381 |
$1.77M |
| 11042 |
|
155,761 |
65,747 |
$1.34M |
| 99310 |
Prolong nursin fac eval 15m |
5,337 |
3,986 |
$181K |
| 99307 |
|
17,498 |
13,479 |
$170K |
| 17250 |
|
43,596 |
20,185 |
$154K |
| 99305 |
|
5,267 |
4,757 |
$138K |
| 99304 |
|
4,754 |
4,167 |
$109K |
| A6196 |
Alginate dressing <=16 sq in |
6,702 |
5,052 |
$94K |
| 11044 |
|
4,406 |
1,916 |
$81K |
| A6010 |
Collagen based wound filler |
1,162 |
912 |
$62K |
| 11046 |
|
3,068 |
1,650 |
$48K |
| 97597 |
|
9,870 |
4,571 |
$37K |
| A6219 |
Gauze <= 16 sq in w/border |
10,961 |
8,216 |
$36K |
| 99306 |
Prolong nursin fac eval 15m |
428 |
412 |
$32K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,376 |
1,041 |
$10K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,345 |
1,798 |
$5K |
| G0406 |
Inpt/tele follow up 15 |
788 |
462 |
$4K |
| A6212 |
Foam drg <=16 sq in w/border |
796 |
679 |
$3K |
| G0407 |
Inpt/tele follow up 25 |
248 |
167 |
$2K |
| A6248 |
Hydrogel drsg gel filler |
280 |
233 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,680 |
1,290 |
$1K |
| A6021 |
Collagen dressing <=16 sq in |
285 |
228 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
502 |
455 |
$433.99 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
15 |
13 |
$183.41 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
148 |
124 |
$48.47 |
| A6197 |
Alginate drsg >16 <=48 sq in |
61 |
55 |
$0.00 |
| A4450 |
Non-waterproof tape |
29 |
28 |
$0.00 |
| 15271 |
|
40 |
12 |
$0.00 |
| 0640T |
|
13 |
12 |
$0.00 |
| 11047 |
|
131 |
71 |
$-169.89 |
| 97598 |
|
31 |
24 |
$-522.72 |
| 11045 |
|
1,874 |
1,096 |
$-3216.41 |
| 97610 |
|
2,855 |
1,063 |
$-49452.13 |