| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
5,462 |
4,851 |
$314K |
| A6021 |
Collagen dressing <=16 sq in |
2,439 |
2,242 |
$309K |
| A6212 |
Foam drg <=16 sq in w/border |
4,524 |
3,982 |
$183K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,558 |
4,078 |
$136K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,036 |
918 |
$117K |
| A6449 |
Lt compres band >=3" <5"/yd |
4,808 |
4,359 |
$105K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
2,636 |
2,452 |
$52K |
| A4452 |
Waterproof tape |
7,142 |
6,509 |
$50K |
| A6402 |
Sterile gauze <= 16 sq in |
10,837 |
9,793 |
$45K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,566 |
2,285 |
$40K |
| A6446 |
Conform band s w>=3" <5"/yd |
4,083 |
3,749 |
$28K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
1,416 |
1,303 |
$21K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
632 |
569 |
$17K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,071 |
979 |
$16K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
372 |
332 |
$15K |
| A4450 |
Non-waterproof tape |
5,468 |
4,939 |
$11K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
231 |
206 |
$9K |
| A6454 |
Self-adher band w>=3" <5"/yd |
675 |
621 |
$7K |
| A6199 |
Alginate drsg wound filler |
165 |
144 |
$7K |
| A6219 |
Gauze <= 16 sq in w/border |
1,015 |
923 |
$5K |
| A6457 |
Tubular dressing |
1,759 |
1,608 |
$4K |
| A6545 |
Grad com non-elastic bk surg |
277 |
191 |
$3K |
| A6248 |
Hydrogel drsg gel filler |
53 |
53 |
$185.64 |
| A6445 |
Conform band s w <3"/yd |
29 |
25 |
$131.77 |
| A6206 |
Contact layer <= 16 sq in |
27 |
25 |
$88.87 |
| A6207 |
Contact layer >16<= 48 sq in |
29 |
27 |
$47.86 |