| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
11,099 |
10,316 |
$419K |
| A6021 |
Collagen dressing <=16 sq in |
3,850 |
3,585 |
$294K |
| A4623 |
Tracheostomy inner cannula |
4,558 |
4,419 |
$202K |
| A6446 |
Conform band s w>=3" <5"/yd |
12,062 |
11,184 |
$144K |
| A6219 |
Gauze <= 16 sq in w/border |
8,643 |
7,890 |
$122K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,097 |
3,825 |
$102K |
| A6197 |
Alginate drsg >16 <=48 sq in |
923 |
888 |
$93K |
| A4452 |
Waterproof tape |
11,217 |
10,558 |
$76K |
| A7526 |
Tracheostomy tube collar |
4,745 |
4,603 |
$71K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
4,962 |
4,664 |
$59K |
| A4629 |
Tracheostomy care kit |
2,944 |
2,851 |
$58K |
| A6212 |
Foam drg <=16 sq in w/border |
1,677 |
1,598 |
$42K |
| A6402 |
Sterile gauze <= 16 sq in |
10,436 |
9,770 |
$28K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,089 |
1,005 |
$23K |
| A5120 |
Skin barrier, wipe or swab |
3,473 |
3,328 |
$18K |
| B4035 |
Enteral feed supp pump per d |
834 |
785 |
$17K |
| A6449 |
Lt compres band >=3" <5"/yd |
954 |
888 |
$17K |
| A6248 |
Hydrogel drsg gel filler |
1,120 |
1,056 |
$13K |
| B4152 |
Ef calorie dense>/=1.5kcal |
445 |
414 |
$10K |
| A7521 |
Trach/laryn tube cuffed |
630 |
600 |
$9K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
737 |
697 |
$9K |
| A5061 |
Pouch drainable w barrier at |
955 |
922 |
$7K |
| A6010 |
Collagen based wound filler |
153 |
141 |
$6K |
| A4314 |
Cath w/drainage 2-way latex |
1,677 |
1,606 |
$5K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
212 |
203 |
$4K |
| A4409 |
Ost skn barr convex <=4 sq i |
526 |
503 |
$4K |
| A4450 |
Non-waterproof tape |
2,222 |
2,080 |
$3K |
| A6266 |
Impreg gauze no h20/sal/yard |
125 |
120 |
$2K |
| A4371 |
Skin barrier powder per oz |
3,297 |
3,153 |
$2K |
| A5063 |
Drain ostomy pouch w/flange |
779 |
742 |
$2K |
| A4311 |
Catheter w/o bag 2-way latex |
1,101 |
1,062 |
$2K |
| A4425 |
Ost pch drain for barrier fl |
345 |
319 |
$2K |
| B4154 |
Ef spec metabolic noninherit |
80 |
78 |
$2K |
| A7520 |
Trach/laryn tube non-cuffed |
104 |
99 |
$1K |
| B4150 |
Ef complet w/intact nutrient |
154 |
150 |
$1K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
102 |
90 |
$867.67 |
| B9002 |
Enter nutr inf pump any type |
271 |
266 |
$678.81 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
75 |
72 |
$285.31 |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
27 |
25 |
$220.06 |
| A4357 |
Bedside drainage bag |
160 |
147 |
$202.70 |
| A6203 |
Composite drsg <= 16 sq in |
12 |
12 |
$111.08 |
| E0776 |
Iv pole |
508 |
506 |
$99.21 |