| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,337 |
2,142 |
$893K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,023 |
941 |
$407K |
| A6197 |
Alginate drsg >16 <=48 sq in |
2,094 |
1,948 |
$389K |
| A6212 |
Foam drg <=16 sq in w/border |
818 |
741 |
$176K |
| A6250 |
Skin seal protect moisturizr |
834 |
780 |
$165K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
763 |
704 |
$140K |
| A4452 |
Waterproof tape |
3,157 |
2,943 |
$124K |
| A6154 |
Wound pouch each |
729 |
630 |
$110K |
| A6402 |
Sterile gauze <= 16 sq in |
4,564 |
4,156 |
$104K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
572 |
523 |
$95K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,519 |
1,413 |
$84K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
772 |
730 |
$72K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,508 |
2,325 |
$70K |
| A4216 |
Sterile water/saline, 10 ml |
2,446 |
2,261 |
$53K |
| A6258 |
Transparent film >16<=48 in |
224 |
203 |
$49K |
| A6260 |
Wound cleanser any type/size |
2,280 |
2,134 |
$46K |
| A6452 |
High compres band w>=3"<5"yd |
208 |
199 |
$41K |
| A4927 |
Non-sterile gloves |
3,862 |
3,600 |
$26K |
| A6219 |
Gauze <= 16 sq in w/border |
418 |
371 |
$23K |
| A6248 |
Hydrogel drsg gel filler |
683 |
640 |
$19K |
| T4541 |
Large disposable underpad |
538 |
495 |
$16K |
| A4385 |
Ost skn barrier sld ext wear |
266 |
244 |
$9K |
| T4527 |
Adult size pull-on lg |
72 |
69 |
$6K |
| A6196 |
Alginate dressing <=16 sq in |
53 |
53 |
$6K |
| A5112 |
Urinary leg bag |
55 |
52 |
$5K |
| A4406 |
Pectin based ostomy paste |
284 |
269 |
$3K |
| A4322 |
Irrigation syringe |
54 |
51 |
$3K |
| A4372 |
Skin barrier solid 4x4 equiv |
38 |
37 |
$2K |
| A4670 |
Automatic bp monitor, dial |
49 |
48 |
$2K |
| A4456 |
Adhesive remover, wipes |
151 |
129 |
$2K |
| A6450 |
Lt compres band >=5"/yd |
26 |
25 |
$1K |
| A4371 |
Skin barrier powder per oz |
329 |
314 |
$999.32 |
| A4247 |
Betadine/iodine swabs/wipes |
185 |
169 |
$931.72 |
| A5120 |
Skin barrier, wipe or swab |
49 |
49 |
$435.99 |
| A4357 |
Bedside drainage bag |
14 |
12 |
$411.12 |