| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
106 |
67 |
$20K |
| A4409 |
Ost skn barr convex <=4 sq i |
379 |
202 |
$16K |
| A4425 |
Ost pch drain for barrier fl |
364 |
202 |
$10K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
156 |
111 |
$8K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
151 |
91 |
$7K |
| A4452 |
Waterproof tape |
492 |
330 |
$5K |
| A5063 |
Drain ostomy pouch w/flange |
226 |
121 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
571 |
378 |
$5K |
| A4357 |
Bedside drainage bag |
508 |
278 |
$4K |
| A6197 |
Alginate drsg >16 <=48 sq in |
16 |
12 |
$4K |
| A4406 |
Pectin based ostomy paste |
340 |
204 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
184 |
113 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
690 |
422 |
$3K |
| A4450 |
Non-waterproof tape |
84 |
60 |
$304.23 |
| A6260 |
Wound cleanser any type/size |
16 |
12 |
$289.07 |
| A6216 |
Non-sterile gauze<=16 sq in |
39 |
24 |
$237.76 |
| A4358 |
Urinary leg or abdomen bag |
26 |
12 |
$204.67 |