| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Straight tip urine catheter |
1,193 |
967 |
$234K |
| A6197 |
Alginate drsg >16 <=48 sq in |
176 |
148 |
$90K |
| A6196 |
Alginate dressing <=16 sq in |
270 |
219 |
$41K |
| A6446 |
Conform band s w>=3" <5"/yd |
848 |
701 |
$28K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
335 |
285 |
$21K |
| A6212 |
Foam drg <=16 sq in w/border |
138 |
114 |
$18K |
| A6402 |
Sterile gauze <= 16 sq in |
1,799 |
1,587 |
$15K |
| A4452 |
Waterproof tape |
1,221 |
1,084 |
$12K |
| A4353 |
Intermittent urinary cath |
15 |
12 |
$10K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
47 |
43 |
$6K |
| A6021 |
Collagen dressing <=16 sq in |
13 |
13 |
$6K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
16 |
15 |
$762.36 |
| A4216 |
Sterile water/saline, 10 ml |
215 |
193 |
$681.75 |
| A4402 |
Lubricant per ounce |
44 |
36 |
$240.72 |
| A6457 |
Tubular dressing |
14 |
14 |
$131.26 |
| A6260 |
Wound cleanser any type/size |
41 |
39 |
$0.00 |