| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
106 |
67 |
$20K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
379 |
202 |
$16K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
364 |
202 |
$10K |
| 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 |
156 |
111 |
$8K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
151 |
91 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
492 |
330 |
$5K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
226 |
121 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
571 |
378 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
508 |
278 |
$4K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
16 |
12 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
340 |
204 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
184 |
113 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
690 |
422 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
84 |
60 |
$304.23 |
| A6260 |
Wound cleansers, any type, any size |
16 |
12 |
$289.07 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
39 |
24 |
$237.76 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
26 |
12 |
$204.67 |