| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
652 |
648 |
$77K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
799 |
754 |
$35K |
| A6212 |
Foam drg <=16 sq in w/border |
252 |
223 |
$22K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,241 |
1,145 |
$17K |
| A4452 |
Waterproof tape |
682 |
634 |
$12K |
| A4409 |
Ost skn barr convex <=4 sq i |
280 |
273 |
$11K |
| A4385 |
Ost skn barrier sld ext wear |
334 |
317 |
$10K |
| A6402 |
Sterile gauze <= 16 sq in |
1,659 |
1,525 |
$9K |
| A6197 |
Alginate drsg >16 <=48 sq in |
44 |
40 |
$7K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
69 |
65 |
$6K |
| A4425 |
Ost pch drain for barrier fl |
133 |
131 |
$4K |
| A4450 |
Non-waterproof tape |
950 |
891 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
410 |
381 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
752 |
712 |
$2K |
| A4456 |
Adhesive remover, wipes |
420 |
402 |
$2K |
| A4927 |
Non-sterile gloves |
247 |
234 |
$2K |
| A4394 |
Ostomy pouch liq deodorant |
90 |
88 |
$1K |
| K0553 |
Ther cgm supply allowance |
19 |
19 |
$848.16 |
| A6260 |
Wound cleanser any type/size |
238 |
213 |
$839.59 |
| A5063 |
Drain ostomy pouch w/flange |
26 |
26 |
$609.92 |
| A4362 |
Solid skin barrier |
14 |
14 |
$535.84 |
| A4371 |
Skin barrier powder per oz |
48 |
47 |
$96.77 |