| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
3,997 |
2,883 |
$419K |
| A6196 |
Alginate dressing <=16 sq in |
2,254 |
1,848 |
$162K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,048 |
827 |
$162K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,279 |
1,990 |
$157K |
| A6021 |
Collagen dressing <=16 sq in |
1,503 |
1,272 |
$152K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,267 |
1,966 |
$85K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
523 |
395 |
$65K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
887 |
780 |
$55K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,029 |
895 |
$29K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,454 |
4,019 |
$21K |
| A6449 |
Lt compres band >=3" <5"/yd |
482 |
376 |
$20K |
| A4452 |
Waterproof tape |
2,361 |
2,047 |
$18K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
568 |
487 |
$17K |
| A6446 |
Conform band s w>=3" <5"/yd |
702 |
615 |
$12K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
158 |
147 |
$9K |
| A4450 |
Non-waterproof tape |
2,051 |
1,782 |
$6K |
| A6260 |
Wound cleanser any type/size |
326 |
292 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
960 |
883 |
$4K |
| A6248 |
Hydrogel drsg gel filler |
153 |
139 |
$4K |
| A6199 |
Alginate drsg wound filler |
63 |
38 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
357 |
316 |
$2K |
| A6454 |
Self-adher band w>=3" <5"/yd |
95 |
68 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
111 |
95 |
$1K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
41 |
37 |
$680.60 |
| A4217 |
Sterile water/saline, 500 ml |
457 |
405 |
$636.56 |
| A6457 |
Tubular dressing |
52 |
37 |
$615.79 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
15 |
15 |
$128.07 |
| A5120 |
Skin barrier, wipe or swab |
39 |
32 |
$86.62 |
| A4927 |
Non-sterile gloves |
29 |
28 |
$68.82 |