| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
2,927 |
2,708 |
$1.04M |
| A6196 |
Alginate dressing <=16 sq in |
6,004 |
5,425 |
$733K |
| A6021 |
Collagen dressing <=16 sq in |
3,071 |
2,868 |
$731K |
| A6212 |
Foam drg <=16 sq in w/border |
4,102 |
3,640 |
$424K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,499 |
4,180 |
$395K |
| A6266 |
Impreg gauze no h20/sal/yard |
3,431 |
3,206 |
$290K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,703 |
2,461 |
$288K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
675 |
628 |
$286K |
| A4452 |
Waterproof tape |
8,442 |
7,789 |
$195K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
785 |
735 |
$186K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,213 |
4,729 |
$171K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
3,550 |
3,297 |
$161K |
| A4385 |
Ost skn barrier sld ext wear |
2,364 |
2,109 |
$148K |
| A4425 |
Ost pch drain for barrier fl |
2,392 |
2,145 |
$132K |
| Q0508 |
Mis sup/acc imp vad |
179 |
165 |
$126K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,566 |
1,394 |
$122K |
| A5121 |
Solid skin barrier 6x6 |
1,701 |
1,483 |
$80K |
| A6216 |
Non-sterile gauze<=16 sq in |
9,045 |
8,854 |
$74K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
972 |
861 |
$46K |
| A4407 |
Ext wear ost skn barr <=4sq" |
230 |
211 |
$45K |
| A4629 |
Tracheostomy care kit |
918 |
821 |
$40K |
| A4456 |
Adhesive remover, wipes |
3,446 |
3,094 |
$34K |
| A6207 |
Contact layer >16<= 48 sq in |
176 |
168 |
$33K |
| A6219 |
Gauze <= 16 sq in w/border |
1,799 |
1,608 |
$30K |
| A4357 |
Bedside drainage bag |
4,848 |
4,161 |
$30K |
| A6010 |
Collagen based wound filler |
77 |
65 |
$28K |
| A4394 |
Ostomy pouch liq deodorant |
2,223 |
1,959 |
$28K |
| A5063 |
Drain ostomy pouch w/flange |
985 |
857 |
$27K |
| A4406 |
Pectin based ostomy paste |
2,419 |
2,181 |
$26K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
595 |
559 |
$24K |
| A4338 |
Indwelling catheter latex |
4,102 |
3,518 |
$22K |
| A5120 |
Skin barrier, wipe or swab |
3,785 |
3,373 |
$21K |
| A4623 |
Tracheostomy inner cannula |
490 |
442 |
$19K |
| A4310 |
Insert tray w/o bag/cath |
4,878 |
4,170 |
$18K |
| A6402 |
Sterile gauze <= 16 sq in |
2,523 |
2,354 |
$17K |
| A6454 |
Self-adher band w>=3" <5"/yd |
651 |
612 |
$16K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
222 |
215 |
$14K |
| A6457 |
Tubular dressing |
568 |
552 |
$14K |
| B4152 |
Ef calorie dense>/=1.5kcal |
463 |
378 |
$13K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
129 |
119 |
$11K |
| A5061 |
Pouch drainable w barrier at |
311 |
274 |
$7K |
| B4034 |
Enter feed supkit syr by day |
816 |
685 |
$7K |
| A6022 |
Collagen drsg>16<=48 sq in |
12 |
12 |
$7K |
| A6261 |
Wound filler gel/paste /oz |
295 |
274 |
$6K |
| A4333 |
Urinary cath anchor device |
1,077 |
913 |
$6K |
| A6449 |
Lt compres band >=3" <5"/yd |
102 |
99 |
$6K |
| A6240 |
Hydrocolld drg filler paste |
69 |
62 |
$5K |
| A4450 |
Non-waterproof tape |
1,630 |
1,509 |
$5K |
| A4371 |
Skin barrier powder per oz |
1,852 |
1,635 |
$3K |
| A5131 |
Appliance cleaner |
578 |
475 |
$3K |
| A6248 |
Hydrogel drsg gel filler |
27 |
26 |
$1K |
| A4362 |
Solid skin barrier |
13 |
12 |
$767.68 |
| A4358 |
Urinary leg or abdomen bag |
79 |
74 |
$473.10 |
| A6441 |
Pad band w>=3" <5"/yd |
27 |
24 |
$411.85 |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
28 |
26 |
$409.80 |
| A6260 |
Wound cleanser any type/size |
1,064 |
1,043 |
$363.47 |
| A6206 |
Contact layer <= 16 sq in |
12 |
12 |
$357.27 |
| A4247 |
Betadine/iodine swabs/wipes |
13 |
13 |
$345.08 |
| B4035 |
Enteral feed supp pump per d |
20 |
15 |
$287.56 |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
12 |
12 |
$276.78 |
| A4344 |
Cath indw foley 2 way silicn |
38 |
37 |
$244.96 |
| A4217 |
Sterile water/saline, 500 ml |
73 |
69 |
$162.07 |