| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
432 |
410 |
$11K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
28 |
27 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
161 |
159 |
$10K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
231 |
224 |
$9K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
60 |
55 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
170 |
154 |
$6K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
111 |
110 |
$5K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
12 |
12 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
420 |
394 |
$5K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
50 |
40 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
214 |
193 |
$3K |
| A4456 |
Adhesive remover, wipes, any type, each |
181 |
161 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
27 |
25 |
$1K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13 |
13 |
$1K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
26 |
26 |
$627.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
371 |
356 |
$508.81 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
16 |
12 |
$476.28 |
| A4371 |
Ostomy skin barrier, powder, per oz |
13 |
12 |
$246.22 |