| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11042 |
|
47,550 |
19,823 |
$737K |
| 99308 |
|
53,947 |
27,768 |
$388K |
| 99309 |
|
32,511 |
19,276 |
$345K |
| 17250 |
|
16,805 |
7,378 |
$221K |
| 11043 |
|
4,391 |
1,776 |
$100K |
| 97597 |
|
2,278 |
993 |
$33K |
| 99307 |
|
3,995 |
3,065 |
$26K |
| 99304 |
|
1,714 |
1,497 |
$24K |
| 99305 |
|
912 |
814 |
$22K |
| 97610 |
|
355 |
108 |
$5K |
| 11044 |
|
70 |
27 |
$5K |
| 99310 |
Prolong nursin fac eval 15m |
214 |
125 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
2,001 |
1,384 |
$474.64 |
| G0406 |
Inpt/tele follow up 15 |
119 |
76 |
$322.87 |
| 11045 |
|
27 |
21 |
$240.99 |
| A6219 |
Gauze <= 16 sq in w/border |
3,561 |
2,581 |
$140.03 |
| 0640T |
|
84 |
34 |
$69.28 |
| A6446 |
Conform band s w>=3" <5"/yd |
1,053 |
671 |
$32.77 |
| A6212 |
Foam drg <=16 sq in w/border |
708 |
538 |
$0.00 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
32 |
29 |
$0.00 |
| A6010 |
Collagen based wound filler |
17 |
14 |
$0.00 |
| A6021 |
Collagen dressing <=16 sq in |
110 |
88 |
$0.00 |
| A6248 |
Hydrogel drsg gel filler |
70 |
50 |
$0.00 |
| G0407 |
Inpt/tele follow up 25 |
85 |
55 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
52 |
39 |
$0.00 |
| Q4271 |
Complete ft per sq cm |
50 |
12 |
$0.00 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
359 |
246 |
$0.00 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
339 |
230 |
$0.00 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
87 |
55 |
$0.00 |