| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
1,128 |
908 |
$240K |
| A6021 |
Collagen dressing <=16 sq in |
616 |
532 |
$123K |
| A6196 |
Alginate dressing <=16 sq in |
1,460 |
1,167 |
$120K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,123 |
1,630 |
$106K |
| A6212 |
Foam drg <=16 sq in w/border |
761 |
635 |
$49K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,062 |
1,636 |
$31K |
| A4452 |
Waterproof tape |
2,884 |
2,347 |
$25K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
107 |
80 |
$12K |
| A6219 |
Gauze <= 16 sq in w/border |
681 |
598 |
$10K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
220 |
178 |
$9K |
| A6402 |
Sterile gauze <= 16 sq in |
3,136 |
2,629 |
$9K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
69 |
56 |
$8K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
80 |
64 |
$3K |
| A4450 |
Non-waterproof tape |
176 |
131 |
$475.38 |