| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6023 |
Collagen dressing >48 sq in |
124 |
113 |
$175K |
| A6197 |
Alginate drsg >16 <=48 sq in |
594 |
540 |
$52K |
| A6021 |
Collagen dressing <=16 sq in |
444 |
415 |
$31K |
| A6196 |
Alginate dressing <=16 sq in |
717 |
635 |
$23K |
| A6214 |
Foam drg > 48 sq in w/border |
754 |
680 |
$23K |
| A6212 |
Foam drg <=16 sq in w/border |
983 |
882 |
$19K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
327 |
303 |
$13K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
755 |
685 |
$5K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
684 |
639 |
$4K |
| A6219 |
Gauze <= 16 sq in w/border |
1,092 |
971 |
$4K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
103 |
96 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
437 |
403 |
$617.08 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
28 |
26 |
$379.01 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
31 |
28 |
$279.61 |
| A4452 |
Waterproof tape |
484 |
451 |
$61.81 |
| A6248 |
Hydrogel drsg gel filler |
109 |
104 |
$18.38 |