| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Pneumat walking boot pre cst |
1,262 |
1,114 |
$229K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,217 |
1,068 |
$81K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,525 |
1,404 |
$65K |
| A4425 |
Ost pch drain for barrier fl |
1,421 |
1,280 |
$62K |
| A6402 |
Sterile gauze <= 16 sq in |
5,866 |
5,247 |
$54K |
| A6196 |
Alginate dressing <=16 sq in |
499 |
408 |
$43K |
| A4351 |
Straight tip urine catheter |
547 |
456 |
$42K |
| A6219 |
Gauze <= 16 sq in w/border |
1,564 |
1,403 |
$38K |
| A4452 |
Waterproof tape |
2,759 |
2,434 |
$35K |
| A4385 |
Ost skn barrier sld ext wear |
688 |
614 |
$33K |
| A4314 |
Cath w/drainage 2-way latex |
1,193 |
1,074 |
$28K |
| L3670 |
So acro/clav can web pre ots |
367 |
347 |
$27K |
| A6212 |
Foam drg <=16 sq in w/border |
407 |
344 |
$26K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,303 |
1,082 |
$26K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
599 |
522 |
$25K |
| A6260 |
Wound cleanser any type/size |
2,457 |
2,259 |
$23K |
| L3908 |
Who cock-up nonmolde pre ots |
466 |
413 |
$20K |
| L3807 |
Whfo w/o joints pre cst |
86 |
80 |
$13K |
| A6197 |
Alginate drsg >16 <=48 sq in |
63 |
51 |
$11K |
| A4407 |
Ext wear ost skn barr <=4sq" |
58 |
51 |
$8K |
| A4456 |
Adhesive remover, wipes |
943 |
842 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
1,503 |
1,344 |
$6K |
| A4406 |
Pectin based ostomy paste |
681 |
610 |
$5K |
| L1902 |
Afo ankle gauntlet pre ots |
66 |
60 |
$4K |
| A4357 |
Bedside drainage bag |
640 |
558 |
$4K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
58 |
53 |
$4K |
| A4362 |
Solid skin barrier |
155 |
132 |
$3K |
| E0114 |
Crutch underarm pair no wood |
113 |
104 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
457 |
402 |
$2K |
| A4333 |
Urinary cath anchor device |
304 |
280 |
$2K |
| A4450 |
Non-waterproof tape |
828 |
760 |
$2K |
| L3660 |
So 8 ab rstr can/web pre ots |
30 |
26 |
$2K |
| L1820 |
Ko elas w/ condyle pads & jo |
16 |
13 |
$1K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
32 |
26 |
$1K |
| A4371 |
Skin barrier powder per oz |
400 |
353 |
$1K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
12 |
12 |
$568.96 |
| A6407 |
Packing strips, non-impreg |
13 |
13 |
$481.20 |
| A6216 |
Non-sterile gauze<=16 sq in |
208 |
184 |
$393.48 |
| A4394 |
Ostomy pouch liq deodorant |
28 |
24 |
$284.50 |
| A4320 |
Irrigation tray |
52 |
49 |
$215.49 |
| A4216 |
Sterile water/saline, 10 ml |
42 |
30 |
$0.00 |