| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
3,833 |
3,328 |
$596K |
| A6196 |
Alginate dressing <=16 sq in |
4,165 |
3,669 |
$289K |
| A6212 |
Foam drg <=16 sq in w/border |
5,311 |
4,479 |
$231K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
3,343 |
2,904 |
$222K |
| A6021 |
Collagen dressing <=16 sq in |
2,182 |
1,924 |
$200K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,768 |
4,233 |
$158K |
| A6446 |
Conform band s w>=3" <5"/yd |
8,634 |
7,331 |
$122K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
894 |
570 |
$111K |
| A4216 |
Sterile water/saline, 10 ml |
9,307 |
8,246 |
$81K |
| A4452 |
Waterproof tape |
6,346 |
5,534 |
$64K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
2,257 |
1,987 |
$48K |
| A6402 |
Sterile gauze <= 16 sq in |
7,835 |
6,836 |
$39K |
| A6216 |
Non-sterile gauze<=16 sq in |
7,102 |
6,227 |
$33K |
| A6199 |
Alginate drsg wound filler |
568 |
505 |
$27K |
| A6266 |
Impreg gauze no h20/sal/yard |
620 |
529 |
$26K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,429 |
1,249 |
$26K |
| A6219 |
Gauze <= 16 sq in w/border |
1,549 |
1,350 |
$21K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
491 |
436 |
$21K |
| A4927 |
Non-sterile gloves |
3,323 |
2,956 |
$19K |
| A4239 |
Non-adju cgm supply allow |
361 |
271 |
$18K |
| A4385 |
Ost skn barrier sld ext wear |
855 |
776 |
$17K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,922 |
1,655 |
$15K |
| A4407 |
Ext wear ost skn barr <=4sq" |
345 |
309 |
$15K |
| A4314 |
Cath w/drainage 2-way latex |
2,404 |
2,226 |
$12K |
| A4362 |
Solid skin barrier |
596 |
549 |
$12K |
| A6452 |
High compres band w>=3"<5"yd |
252 |
211 |
$12K |
| A4409 |
Ost skn barr convex <=4 sq i |
446 |
395 |
$12K |
| A4425 |
Ost pch drain for barrier fl |
732 |
685 |
$11K |
| T4541 |
Large disposable underpad |
352 |
322 |
$7K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,297 |
1,069 |
$7K |
| A4450 |
Non-waterproof tape |
2,560 |
2,292 |
$6K |
| A4358 |
Urinary leg or abdomen bag |
1,382 |
1,291 |
$5K |
| A5056 |
1 pc ost pouch w filter |
93 |
86 |
$5K |
| A4357 |
Bedside drainage bag |
1,765 |
1,624 |
$4K |
| A6450 |
Lt compres band >=5"/yd |
332 |
281 |
$4K |
| A4333 |
Urinary cath anchor device |
1,097 |
1,014 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
1,502 |
1,376 |
$4K |
| A6445 |
Conform band s w <3"/yd |
206 |
193 |
$2K |
| A6203 |
Composite drsg <= 16 sq in |
121 |
110 |
$2K |
| A6240 |
Hydrocolld drg filler paste |
202 |
185 |
$2K |
| A4406 |
Pectin based ostomy paste |
418 |
384 |
$2K |
| A6207 |
Contact layer >16<= 48 sq in |
32 |
13 |
$2K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
110 |
91 |
$1K |
| A4320 |
Irrigation tray |
922 |
861 |
$1K |
| A4371 |
Skin barrier powder per oz |
629 |
575 |
$1K |
| A6022 |
Collagen drsg>16<=48 sq in |
13 |
13 |
$859.84 |
| A4456 |
Adhesive remover, wipes |
484 |
459 |
$763.29 |
| A4334 |
Urinary cath leg strap |
559 |
515 |
$591.97 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
65 |
58 |
$398.09 |
| A6441 |
Pad band w>=3" <5"/yd |
124 |
105 |
$394.81 |
| A4315 |
Cath w/drainage 2-way silcne |
15 |
12 |
$235.78 |
| A4367 |
Ostomy belt |
27 |
25 |
$104.16 |
| A6248 |
Hydrogel drsg gel filler |
14 |
13 |
$87.04 |
| A6457 |
Tubular dressing |
65 |
58 |
$81.57 |
| A4394 |
Ostomy pouch liq deodorant |
12 |
12 |
$23.80 |