| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11043 |
|
42,118 |
14,712 |
$1.73M |
| 99308 |
|
81,703 |
37,277 |
$1.23M |
| 99309 |
|
36,979 |
21,602 |
$696K |
| 11042 |
|
51,307 |
20,983 |
$366K |
| 17250 |
|
15,668 |
6,408 |
$139K |
| 99307 |
|
4,176 |
2,969 |
$41K |
| Q4191 |
Restorigin 1 sq cm |
157 |
25 |
$28K |
| 99310 |
Prolong nursin fac eval 15m |
431 |
211 |
$14K |
| 99305 |
|
376 |
303 |
$10K |
| 97597 |
|
3,288 |
1,251 |
$9K |
| 97610 |
|
440 |
140 |
$6K |
| 11044 |
|
270 |
102 |
$5K |
| 99304 |
|
150 |
131 |
$3K |
| 99306 |
Prolong nursin fac eval 15m |
14 |
13 |
$1K |
| G0407 |
Inpt/tele follow up 25 |
91 |
64 |
$498.05 |
| G0406 |
Inpt/tele follow up 15 |
124 |
83 |
$323.82 |
| A6219 |
Gauze <= 16 sq in w/border |
3,167 |
2,487 |
$21.06 |
| A6446 |
Conform band s w>=3" <5"/yd |
693 |
532 |
$17.70 |
| A6196 |
Alginate dressing <=16 sq in |
2,418 |
1,852 |
$0.00 |
| A6212 |
Foam drg <=16 sq in w/border |
196 |
168 |
$0.00 |
| A6402 |
Sterile gauze <= 16 sq in |
207 |
177 |
$0.00 |
| A6248 |
Hydrogel drsg gel filler |
56 |
53 |
$0.00 |
| A6021 |
Collagen dressing <=16 sq in |
32 |
24 |
$0.00 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
758 |
542 |
$0.00 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
60 |
41 |
$0.00 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
311 |
280 |
$0.00 |
| 11046 |
|
39 |
12 |
$0.00 |
| A4450 |
Non-waterproof tape |
15 |
14 |
$0.00 |