| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6021 |
Collagen dressing <=16 sq in |
5,026 |
4,139 |
$566K |
| A6196 |
Alginate dressing <=16 sq in |
5,723 |
4,676 |
$381K |
| A6266 |
Impreg gauze no h20/sal/yard |
3,496 |
3,031 |
$231K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,408 |
1,118 |
$202K |
| A6212 |
Foam drg <=16 sq in w/border |
4,408 |
3,582 |
$179K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
5,585 |
4,476 |
$156K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
3,145 |
2,574 |
$127K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
873 |
718 |
$83K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,818 |
4,643 |
$72K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
4,043 |
3,462 |
$70K |
| A6402 |
Sterile gauze <= 16 sq in |
9,442 |
7,807 |
$52K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
887 |
710 |
$42K |
| A4452 |
Waterproof tape |
4,992 |
4,135 |
$40K |
| A6452 |
High compres band w>=3"<5"yd |
742 |
602 |
$39K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
652 |
538 |
$26K |
| A4450 |
Non-waterproof tape |
6,707 |
5,586 |
$19K |
| A6010 |
Collagen based wound filler |
98 |
75 |
$19K |
| A6454 |
Self-adher band w>=3" <5"/yd |
921 |
730 |
$18K |
| A6198 |
Alginate dressing > 48 sq in |
62 |
48 |
$15K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
243 |
186 |
$12K |
| A6260 |
Wound cleanser any type/size |
4,498 |
3,651 |
$12K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
841 |
699 |
$12K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,832 |
1,520 |
$11K |
| A6199 |
Alginate drsg wound filler |
298 |
234 |
$11K |
| A4927 |
Non-sterile gloves |
2,382 |
1,917 |
$9K |
| A6219 |
Gauze <= 16 sq in w/border |
958 |
806 |
$8K |
| A6453 |
Self-adher band w <3"/yd |
449 |
358 |
$7K |
| A6545 |
Grad com non-elastic bk surg |
311 |
171 |
$6K |
| A6248 |
Hydrogel drsg gel filler |
274 |
237 |
$5K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
111 |
95 |
$4K |
| A6207 |
Contact layer >16<= 48 sq in |
412 |
335 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
737 |
610 |
$2K |
| A6457 |
Tubular dressing |
520 |
429 |
$1K |
| A6240 |
Hydrocolld drg filler paste |
113 |
93 |
$1K |
| A6407 |
Packing strips, non-impreg |
16 |
13 |
$665.03 |
| A6206 |
Contact layer <= 16 sq in |
82 |
68 |
$562.86 |
| A4216 |
Sterile water/saline, 10 ml |
893 |
708 |
$549.39 |
| A6445 |
Conform band s w <3"/yd |
53 |
39 |
$220.62 |
| A6261 |
Wound filler gel/paste /oz |
70 |
66 |
$217.94 |
| A9270 |
Non-covered item or service |
738 |
603 |
$173.62 |