| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6021 |
Collagen dressing <=16 sq in |
351 |
304 |
$16K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
560 |
467 |
$8K |
| A6196 |
Alginate dressing <=16 sq in |
1,207 |
1,040 |
$7K |
| A6402 |
Sterile gauze <= 16 sq in |
1,536 |
1,348 |
$7K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,209 |
1,078 |
$4K |
| A6212 |
Foam drg <=16 sq in w/border |
722 |
622 |
$4K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
410 |
360 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
413 |
361 |
$2K |
| A6266 |
Impreg gauze no h20/sal/yard |
244 |
203 |
$2K |
| A4452 |
Waterproof tape |
841 |
698 |
$2K |
| A4450 |
Non-waterproof tape |
787 |
694 |
$2K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
382 |
320 |
$1K |
| A6197 |
Alginate drsg >16 <=48 sq in |
77 |
63 |
$468.08 |
| A6545 |
Grad com non-elastic bk surg |
22 |
12 |
$213.86 |
| A6219 |
Gauze <= 16 sq in w/border |
161 |
136 |
$115.76 |
| A6216 |
Non-sterile gauze<=16 sq in |
129 |
113 |
$58.14 |