| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
1,954 |
1,944 |
$1.14M |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,317 |
1,306 |
$452K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
317 |
313 |
$397K |
| A4385 |
Ost skn barrier sld ext wear |
946 |
941 |
$217K |
| A6402 |
Sterile gauze <= 16 sq in |
7,079 |
6,934 |
$212K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,206 |
1,197 |
$171K |
| A6446 |
Conform band s w>=3" <5"/yd |
3,724 |
3,678 |
$166K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
2,615 |
2,592 |
$161K |
| A6212 |
Foam drg <=16 sq in w/border |
895 |
890 |
$143K |
| A4409 |
Ost skn barr convex <=4 sq i |
489 |
488 |
$139K |
| A4425 |
Ost pch drain for barrier fl |
777 |
776 |
$92K |
| A4450 |
Non-waterproof tape |
3,589 |
3,491 |
$84K |
| A4362 |
Solid skin barrier |
645 |
642 |
$80K |
| A4927 |
Non-sterile gloves |
3,242 |
3,217 |
$80K |
| A4217 |
Sterile water/saline, 500 ml |
1,047 |
1,036 |
$57K |
| A4407 |
Ext wear ost skn barr <=4sq" |
122 |
122 |
$52K |
| A6196 |
Alginate dressing <=16 sq in |
220 |
219 |
$52K |
| A6457 |
Tubular dressing |
390 |
380 |
$47K |
| A6021 |
Collagen dressing <=16 sq in |
189 |
187 |
$44K |
| A6404 |
Sterile gauze > 48 sq in |
584 |
581 |
$42K |
| T4541 |
Large disposable underpad |
653 |
650 |
$38K |
| A4338 |
Indwelling catheter latex |
481 |
480 |
$33K |
| A6454 |
Self-adher band w>=3" <5"/yd |
985 |
981 |
$33K |
| A5120 |
Skin barrier, wipe or swab |
2,223 |
2,213 |
$23K |
| A4357 |
Bedside drainage bag |
686 |
685 |
$23K |
| A4358 |
Urinary leg or abdomen bag |
464 |
464 |
$21K |
| T4534 |
Youth size pull-on |
104 |
104 |
$18K |
| A4406 |
Pectin based ostomy paste |
436 |
436 |
$15K |
| A4310 |
Insert tray w/o bag/cath |
464 |
463 |
$14K |
| A4456 |
Adhesive remover, wipes |
1,282 |
1,278 |
$13K |
| A4394 |
Ostomy pouch liq deodorant |
497 |
492 |
$12K |
| 99202 |
|
311 |
311 |
$11K |
| A4371 |
Skin barrier powder per oz |
791 |
787 |
$10K |
| A6240 |
Hydrocolld drg filler paste |
122 |
122 |
$10K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
28 |
28 |
$4K |
| 99212 |
|
150 |
150 |
$3K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
26 |
26 |
$3K |
| A4333 |
Urinary cath anchor device |
49 |
49 |
$3K |
| A6266 |
Impreg gauze no h20/sal/yard |
52 |
52 |
$3K |
| T4526 |
Adult size pull-on med |
39 |
39 |
$2K |
| A4367 |
Ostomy belt |
254 |
251 |
$2K |
| A6199 |
Alginate drsg wound filler |
13 |
13 |
$2K |
| T4535 |
Disposable liner/shield/pad |
40 |
40 |
$2K |
| A6260 |
Wound cleanser any type/size |
25 |
14 |
$2K |
| A4246 |
Betadine/phisohex solution |
44 |
44 |
$2K |
| A4402 |
Lubricant per ounce |
258 |
258 |
$1K |
| T4528 |
Adult size pull-on xl |
12 |
12 |
$1K |
| T4527 |
Adult size pull-on lg |
12 |
12 |
$877.40 |
| A6216 |
Non-sterile gauze<=16 sq in |
54 |
54 |
$678.96 |
| A6219 |
Gauze <= 16 sq in w/border |
12 |
12 |
$645.01 |