| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,255 |
939 |
$716K |
| A4376 |
Drainable rubber pch w fcplt |
969 |
638 |
$637K |
| A6240 |
Hydrocolld drg filler paste |
1,265 |
901 |
$575K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
623 |
487 |
$496K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
1,386 |
946 |
$452K |
| A6244 |
Hydrogel drg >48 in w/o bdr |
474 |
352 |
$397K |
| A6452 |
High compres band w>=3"<5"yd |
572 |
417 |
$286K |
| A4217 |
Sterile water/saline, 500 ml |
1,598 |
1,178 |
$284K |
| A4927 |
Non-sterile gloves |
2,299 |
1,559 |
$209K |
| T4528 |
Adult size pull-on xl |
2,337 |
1,839 |
$207K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
565 |
415 |
$167K |
| A6236 |
Hydrocolld drg > 48 in w/o b |
139 |
114 |
$149K |
| A6260 |
Wound cleanser any type/size |
1,084 |
593 |
$113K |
| T4541 |
Large disposable underpad |
2,173 |
1,564 |
$77K |
| T4534 |
Youth size pull-on |
1,877 |
1,154 |
$74K |
| B4100 |
Food thickener oral |
111 |
101 |
$60K |
| A6447 |
Conform band s w >=5"/yd |
316 |
249 |
$31K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
118 |
85 |
$27K |
| T4524 |
Adult size brief/diaper xl |
425 |
259 |
$14K |
| A4452 |
Waterproof tape |
1,053 |
711 |
$13K |
| A4375 |
Drainable plastic pch w fcpl |
25 |
24 |
$5K |
| T4544 |
Adlt disp und/pull on abv xl |
106 |
73 |
$2K |
| A4357 |
Bedside drainage bag |
206 |
189 |
$2K |
| A4310 |
Insert tray w/o bag/cath |
93 |
86 |
$778.04 |
| A4394 |
Ostomy pouch liq deodorant |
28 |
12 |
$242.32 |