| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,653 |
932 |
$41K |
| A4452 |
Waterproof tape |
1,866 |
1,212 |
$21K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,261 |
1,257 |
$16K |
| L0625 |
Lo flex l1-below l5 pre ots |
333 |
315 |
$13K |
| E0603 |
Electric breast pump |
38 |
37 |
$10K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,466 |
1,763 |
$9K |
| A6449 |
Lt compres band >=3" <5"/yd |
431 |
268 |
$8K |
| A6196 |
Alginate dressing <=16 sq in |
186 |
119 |
$6K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
134 |
87 |
$6K |
| A6212 |
Foam drg <=16 sq in w/border |
274 |
173 |
$5K |
| A6021 |
Collagen dressing <=16 sq in |
138 |
94 |
$3K |
| A4450 |
Non-waterproof tape |
1,169 |
812 |
$3K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
106 |
74 |
$2K |
| A6530 |
Compression stocking bk18-30 |
36 |
13 |
$790.20 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
75 |
52 |
$760.97 |
| A6219 |
Gauze <= 16 sq in w/border |
46 |
28 |
$166.65 |