| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6266 |
Impreg gauze no h20/sal/yard |
1,859 |
1,771 |
$436K |
| A6021 |
Collagen dressing <=16 sq in |
1,213 |
1,120 |
$384K |
| A6196 |
Alginate dressing <=16 sq in |
1,576 |
1,460 |
$233K |
| A6197 |
Alginate drsg >16 <=48 sq in |
664 |
619 |
$223K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,852 |
1,712 |
$138K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,798 |
1,669 |
$133K |
| A4452 |
Waterproof tape |
2,922 |
2,710 |
$67K |
| A6212 |
Foam drg <=16 sq in w/border |
182 |
171 |
$36K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,367 |
1,218 |
$22K |
| A6219 |
Gauze <= 16 sq in w/border |
787 |
743 |
$20K |
| A6449 |
Lt compres band >=3" <5"/yd |
780 |
727 |
$16K |
| A6010 |
Collagen based wound filler |
25 |
25 |
$6K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
15 |
12 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
429 |
402 |
$2K |
| A6450 |
Lt compres band >=5"/yd |
121 |
111 |
$2K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
27 |
25 |
$2K |