| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
17 |
13 |
$3K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
23 |
19 |
$2K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
27 |
27 |
$2K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
15 |
13 |
$670.54 |
| A4452 |
Tape, waterproof, per 18 square inches |
32 |
29 |
$419.20 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
16 |
16 |
$308.66 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
31 |
28 |
$196.58 |