| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
188 |
167 |
$27K |
| A6212 |
Foam drg <=16 sq in w/border |
361 |
304 |
$21K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
463 |
415 |
$18K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
131 |
113 |
$12K |
| A6196 |
Alginate dressing <=16 sq in |
249 |
214 |
$10K |
| A4927 |
Non-sterile gloves |
625 |
600 |
$10K |
| A6446 |
Conform band s w>=3" <5"/yd |
744 |
650 |
$9K |
| A4452 |
Waterproof tape |
576 |
514 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
713 |
646 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
560 |
523 |
$3K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
113 |
101 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
340 |
308 |
$2K |
| A6021 |
Collagen dressing <=16 sq in |
28 |
25 |
$2K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
13 |
12 |
$471.68 |
| A6219 |
Gauze <= 16 sq in w/border |
42 |
38 |
$402.66 |
| A4314 |
Cath w/drainage 2-way latex |
41 |
41 |
$334.27 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
15 |
13 |
$295.82 |
| A5120 |
Skin barrier, wipe or swab |
84 |
73 |
$278.03 |
| A4450 |
Non-waterproof tape |
90 |
87 |
$203.44 |
| A6454 |
Self-adher band w>=3" <5"/yd |
16 |
13 |
$122.22 |
| A4357 |
Bedside drainage bag |
54 |
51 |
$119.36 |
| A4333 |
Urinary cath anchor device |
24 |
24 |
$28.47 |