| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
159 |
147 |
$22K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
202 |
193 |
$10K |
| A6010 |
Collagen based wound filler |
27 |
27 |
$4K |
| A6196 |
Alginate dressing <=16 sq in |
132 |
127 |
$3K |
| A6197 |
Alginate drsg >16 <=48 sq in |
12 |
12 |
$840.39 |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
82 |
80 |
$785.94 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
50 |
47 |
$637.09 |
| A6224 |
Gauze > 48 in no w/sal w/o b |
14 |
14 |
$512.72 |
| A6253 |
Absorpt drg > 48 sq in w/o b |
24 |
24 |
$445.98 |
| A6219 |
Gauze <= 16 sq in w/border |
149 |
139 |
$393.20 |
| A6446 |
Conform band s w>=3" <5"/yd |
13 |
13 |
$38.74 |
| A6248 |
Hydrogel drsg gel filler |
12 |
12 |
$0.56 |