| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6010 |
Collagen based wound filler |
8,298 |
6,898 |
$1000K |
| A6021 |
Collagen dressing <=16 sq in |
7,329 |
6,076 |
$724K |
| A6196 |
Alginate dressing <=16 sq in |
18,729 |
14,972 |
$603K |
| A6197 |
Alginate drsg >16 <=48 sq in |
3,648 |
3,072 |
$572K |
| B4035 |
Enteral feed supp pump per d |
7,785 |
6,447 |
$249K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,207 |
2,015 |
$217K |
| B4154 |
Ef spec metabolic noninherit |
3,130 |
2,003 |
$164K |
| B4152 |
Ef calorie dense>/=1.5kcal |
5,601 |
3,770 |
$158K |
| A6212 |
Foam drg <=16 sq in w/border |
4,358 |
3,525 |
$117K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,895 |
2,478 |
$94K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
455 |
392 |
$61K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
7,072 |
5,742 |
$53K |
| A4314 |
Cath w/drainage 2-way latex |
21,417 |
17,397 |
$51K |
| B4150 |
Ef complet w/intact nutrient |
2,345 |
1,519 |
$45K |
| A4452 |
Waterproof tape |
11,711 |
9,664 |
$43K |
| A6219 |
Gauze <= 16 sq in w/border |
16,722 |
13,118 |
$42K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,249 |
1,896 |
$41K |
| B4034 |
Enter feed supkit syr by day |
2,062 |
1,744 |
$40K |
| A4333 |
Urinary cath anchor device |
12,795 |
10,832 |
$37K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
4,300 |
3,556 |
$32K |
| B9002 |
Enter nutr inf pump any type |
604 |
508 |
$30K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,116 |
1,718 |
$28K |
| B4153 |
Ef hydrolyzed/amino acids |
582 |
281 |
$25K |
| A4385 |
Ost skn barrier sld ext wear |
1,834 |
1,489 |
$23K |
| A6446 |
Conform band s w>=3" <5"/yd |
8,791 |
7,214 |
$21K |
| A4357 |
Bedside drainage bag |
22,040 |
17,944 |
$21K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
338 |
314 |
$16K |
| A4425 |
Ost pch drain for barrier fl |
1,825 |
1,482 |
$16K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
547 |
477 |
$16K |
| A6248 |
Hydrogel drsg gel filler |
1,829 |
1,579 |
$15K |
| A4623 |
Tracheostomy inner cannula |
2,316 |
1,991 |
$13K |
| A5063 |
Drain ostomy pouch w/flange |
1,349 |
1,176 |
$10K |
| A6402 |
Sterile gauze <= 16 sq in |
7,931 |
6,700 |
$10K |
| A6022 |
Collagen drsg>16<=48 sq in |
88 |
83 |
$9K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
795 |
650 |
$8K |
| A4629 |
Tracheostomy care kit |
2,139 |
1,817 |
$7K |
| A4406 |
Pectin based ostomy paste |
2,716 |
2,344 |
$6K |
| B4087 |
Gastro/jejuno tube, std |
1,138 |
1,085 |
$6K |
| A6457 |
Tubular dressing |
273 |
236 |
$6K |
| A4315 |
Cath w/drainage 2-way silcne |
2,075 |
1,814 |
$6K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
466 |
430 |
$5K |
| A7526 |
Tracheostomy tube collar |
2,205 |
1,863 |
$4K |
| A4362 |
Solid skin barrier |
491 |
448 |
$4K |
| A4394 |
Ostomy pouch liq deodorant |
2,158 |
1,875 |
$4K |
| A6450 |
Lt compres band >=5"/yd |
1,056 |
914 |
$4K |
| A4358 |
Urinary leg or abdomen bag |
4,525 |
3,604 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
5,259 |
4,482 |
$4K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
271 |
242 |
$3K |
| A4334 |
Urinary cath leg strap |
6,759 |
5,533 |
$3K |
| A4340 |
Indwelling catheter special |
411 |
303 |
$2K |
| A4456 |
Adhesive remover, wipes |
3,191 |
2,730 |
$2K |
| A4407 |
Ext wear ost skn barr <=4sq" |
93 |
78 |
$2K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
468 |
400 |
$2K |
| A6240 |
Hydrocolld drg filler paste |
245 |
208 |
$2K |
| A6199 |
Alginate drsg wound filler |
46 |
37 |
$1K |
| A4388 |
Drainable pch w ex wear barr |
279 |
248 |
$1K |
| A4354 |
Cath insertion tray w/bag |
337 |
252 |
$892.33 |
| A4371 |
Skin barrier powder per oz |
1,995 |
1,720 |
$866.54 |
| A6210 |
Foam drg >16<=48 sq in w/o b |
19 |
15 |
$705.85 |
| A6454 |
Self-adher band w>=3" <5"/yd |
232 |
201 |
$620.63 |
| A7521 |
Trach/laryn tube cuffed |
455 |
447 |
$464.14 |
| A5061 |
Pouch drainable w barrier at |
56 |
53 |
$377.50 |
| A4424 |
Ost pch drain w bar & filter |
67 |
66 |
$296.21 |
| A4311 |
Catheter w/o bag 2-way latex |
346 |
311 |
$166.03 |
| A6445 |
Conform band s w <3"/yd |
12 |
12 |
$153.04 |
| A4338 |
Indwelling catheter latex |
43 |
27 |
$74.22 |
| A4419 |
Ost pch for bar w flange/flt |
31 |
27 |
$51.12 |
| A4310 |
Insert tray w/o bag/cath |
45 |
28 |
$44.28 |
| A4450 |
Non-waterproof tape |
20 |
20 |
$31.28 |
| A6261 |
Wound filler gel/paste /oz |
212 |
171 |
$27.91 |