| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
188 |
167 |
$27K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
361 |
304 |
$21K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
463 |
415 |
$18K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
131 |
113 |
$12K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
249 |
214 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
625 |
600 |
$10K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
744 |
650 |
$9K |
| A4452 |
Tape, waterproof, per 18 square inches |
576 |
514 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
713 |
646 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
560 |
523 |
$3K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
113 |
101 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
340 |
308 |
$2K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
28 |
25 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$471.68 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
42 |
38 |
$402.66 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
41 |
41 |
$334.27 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
13 |
$295.82 |
| A5120 |
Skin barrier, wipes or swabs, each |
84 |
73 |
$278.03 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
90 |
87 |
$203.44 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
16 |
13 |
$122.22 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
54 |
51 |
$119.36 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
24 |
24 |
$28.47 |