| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6402 |
Sterile gauze <= 16 sq in |
432 |
410 |
$11K |
| A6197 |
Alginate drsg >16 <=48 sq in |
28 |
27 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
161 |
159 |
$10K |
| A6446 |
Conform band s w>=3" <5"/yd |
231 |
224 |
$9K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
60 |
55 |
$7K |
| A4406 |
Pectin based ostomy paste |
170 |
154 |
$6K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
111 |
110 |
$5K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
12 |
12 |
$5K |
| A4927 |
Non-sterile gloves |
420 |
394 |
$5K |
| A5063 |
Drain ostomy pouch w/flange |
50 |
40 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
214 |
193 |
$3K |
| A4456 |
Adhesive remover, wipes |
181 |
161 |
$2K |
| T4541 |
Large disposable underpad |
27 |
25 |
$1K |
| A6212 |
Foam drg <=16 sq in w/border |
13 |
13 |
$1K |
| A6454 |
Self-adher band w>=3" <5"/yd |
26 |
26 |
$627.00 |
| A4450 |
Non-waterproof tape |
371 |
356 |
$508.81 |
| A4357 |
Bedside drainage bag |
16 |
12 |
$476.28 |
| A4371 |
Skin barrier powder per oz |
13 |
12 |
$246.22 |