| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
10,513 |
7,671 |
$92K |
| A6197 |
Alginate drsg >16 <=48 sq in |
4,408 |
3,156 |
$68K |
| A6010 |
Collagen based wound filler |
2,313 |
1,839 |
$33K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,145 |
3,126 |
$18K |
| A6021 |
Collagen dressing <=16 sq in |
1,285 |
1,041 |
$17K |
| A6219 |
Gauze <= 16 sq in w/border |
12,506 |
9,825 |
$14K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
5,167 |
3,864 |
$11K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,137 |
828 |
$10K |
| A6446 |
Conform band s w>=3" <5"/yd |
6,999 |
5,236 |
$8K |
| A6248 |
Hydrogel drsg gel filler |
3,919 |
3,032 |
$7K |
| A4452 |
Waterproof tape |
6,463 |
4,770 |
$6K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
1,671 |
1,238 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
2,708 |
2,151 |
$3K |
| A6212 |
Foam drg <=16 sq in w/border |
687 |
560 |
$3K |
| A4314 |
Cath w/drainage 2-way latex |
1,592 |
1,264 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
1,972 |
1,584 |
$1K |
| A6240 |
Hydrocolld drg filler paste |
775 |
659 |
$1K |
| A4357 |
Bedside drainage bag |
1,792 |
1,459 |
$1K |
| A6449 |
Lt compres band >=3" <5"/yd |
546 |
479 |
$506.51 |
| A6199 |
Alginate drsg wound filler |
18 |
12 |
$336.60 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
65 |
51 |
$323.04 |
| A6231 |
Hydrogel dsg<=16 sq in |
124 |
104 |
$293.23 |
| A6203 |
Composite drsg <= 16 sq in |
249 |
220 |
$270.69 |
| A4338 |
Indwelling catheter latex |
597 |
515 |
$183.97 |
| A4310 |
Insert tray w/o bag/cath |
625 |
531 |
$119.39 |
| A6266 |
Impreg gauze no h20/sal/yard |
17 |
12 |
$20.88 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
19 |
13 |
$18.95 |
| A6454 |
Self-adher band w>=3" <5"/yd |
14 |
12 |
$0.00 |