| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6021 |
Collagen dressing <=16 sq in |
39,728 |
34,608 |
$5.35M |
| A6196 |
Alginate dressing <=16 sq in |
74,346 |
64,163 |
$5.02M |
| A6197 |
Alginate drsg >16 <=48 sq in |
24,430 |
20,526 |
$4.20M |
| A6212 |
Foam drg <=16 sq in w/border |
52,153 |
45,075 |
$3.14M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
68,628 |
59,367 |
$2.53M |
| A6446 |
Conform band s w>=3" <5"/yd |
114,874 |
100,835 |
$1.77M |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
33,892 |
29,955 |
$1.56M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
10,299 |
8,951 |
$1.23M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
11,560 |
9,944 |
$1.08M |
| A6222 |
Gauze <=16 in no w/sal w/o b |
32,991 |
28,839 |
$856K |
| A6402 |
Sterile gauze <= 16 sq in |
144,533 |
126,408 |
$795K |
| A4452 |
Waterproof tape |
77,283 |
67,387 |
$791K |
| A6266 |
Impreg gauze no h20/sal/yard |
13,359 |
11,610 |
$688K |
| A6449 |
Lt compres band >=3" <5"/yd |
15,853 |
13,639 |
$509K |
| A6199 |
Alginate drsg wound filler |
6,439 |
5,547 |
$458K |
| A4385 |
Ost skn barrier sld ext wear |
9,075 |
7,692 |
$452K |
| A4409 |
Ost skn barr convex <=4 sq i |
7,304 |
6,141 |
$448K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
1,529 |
1,275 |
$378K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
9,437 |
8,270 |
$376K |
| A6545 |
Grad com non-elastic bk surg |
9,826 |
7,691 |
$315K |
| A6010 |
Collagen based wound filler |
1,963 |
1,719 |
$314K |
| A4407 |
Ext wear ost skn barr <=4sq" |
3,934 |
3,227 |
$297K |
| A6022 |
Collagen drsg>16<=48 sq in |
1,563 |
1,385 |
$276K |
| A6454 |
Self-adher band w>=3" <5"/yd |
14,168 |
12,326 |
$226K |
| A4450 |
Non-waterproof tape |
68,777 |
60,240 |
$222K |
| A6207 |
Contact layer >16<= 48 sq in |
6,803 |
5,936 |
$200K |
| A6219 |
Gauze <= 16 sq in w/border |
15,563 |
13,672 |
$200K |
| A6452 |
High compres band w>=3"<5"yd |
2,564 |
2,076 |
$193K |
| A4425 |
Ost pch drain for barrier fl |
5,400 |
4,488 |
$190K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
2,154 |
2,013 |
$189K |
| A5063 |
Drain ostomy pouch w/flange |
5,742 |
4,895 |
$183K |
| A4351 |
Straight tip urine catheter |
2,259 |
1,857 |
$171K |
| A4362 |
Solid skin barrier |
4,931 |
4,209 |
$169K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,876 |
2,470 |
$148K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,729 |
1,453 |
$141K |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
623 |
581 |
$131K |
| A6216 |
Non-sterile gauze<=16 sq in |
22,823 |
20,353 |
$122K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
3,042 |
2,679 |
$106K |
| A6248 |
Hydrogel drsg gel filler |
5,062 |
4,485 |
$97K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
2,258 |
2,033 |
$66K |
| A4394 |
Ostomy pouch liq deodorant |
4,475 |
3,683 |
$64K |
| A5061 |
Pouch drainable w barrier at |
1,351 |
1,103 |
$64K |
| A6457 |
Tubular dressing |
16,416 |
14,445 |
$63K |
| A4419 |
Ost pch for bar w flange/flt |
1,775 |
1,421 |
$63K |
| E0603 |
Electric breast pump |
462 |
431 |
$62K |
| A6531 |
Compress stking bk30-40 surg |
3,013 |
2,453 |
$62K |
| A6261 |
Wound filler gel/paste /oz |
4,014 |
3,486 |
$61K |
| A6583 |
Grad com wrap w straps bk |
1,392 |
582 |
$59K |
| A4388 |
Drainable pch w ex wear barr |
1,065 |
883 |
$59K |
| A4406 |
Pectin based ostomy paste |
5,338 |
4,570 |
$58K |
| A6407 |
Packing strips, non-impreg |
2,736 |
2,371 |
$57K |
| A4424 |
Ost pch drain w bar & filter |
1,082 |
902 |
$53K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
92 |
77 |
$53K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
1,290 |
1,097 |
$50K |
| A4456 |
Adhesive remover, wipes |
9,055 |
7,637 |
$49K |
| A4432 |
Os pch urine w bar/fange/tap |
1,574 |
1,364 |
$48K |
| A6441 |
Pad band w>=3" <5"/yd |
5,011 |
4,223 |
$47K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
2,318 |
1,941 |
$44K |
| A5120 |
Skin barrier, wipe or swab |
9,861 |
8,329 |
$41K |
| A5057 |
1 pc ost pou w built-in conv |
479 |
419 |
$37K |
| A4390 |
Drainable pch ex wear convex |
466 |
362 |
$36K |
| A6445 |
Conform band s w <3"/yd |
3,189 |
2,836 |
$34K |
| A6206 |
Contact layer <= 16 sq in |
2,287 |
1,973 |
$34K |
| A6450 |
Lt compres band >=5"/yd |
1,403 |
1,175 |
$32K |
| A4357 |
Bedside drainage bag |
3,566 |
3,077 |
$30K |
| A4371 |
Skin barrier powder per oz |
6,209 |
5,300 |
$20K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
715 |
597 |
$19K |
| A6240 |
Hydrocolld drg filler paste |
1,590 |
1,438 |
$18K |
| A6258 |
Transparent film >16<=48 in |
406 |
352 |
$17K |
| A6203 |
Composite drsg <= 16 sq in |
512 |
438 |
$17K |
| A5056 |
1 pc ost pouch w filter |
292 |
250 |
$16K |
| A6453 |
Self-adher band w <3"/yd |
855 |
728 |
$13K |
| A4349 |
Disposable male external cat |
578 |
469 |
$11K |
| A4367 |
Ostomy belt |
2,719 |
2,311 |
$10K |
| A4389 |
Drainable pch w st wear barr |
205 |
161 |
$9K |
| L4361 |
Pneuma/vac walk boot pre ots |
118 |
85 |
$8K |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
742 |
654 |
$8K |
| A4358 |
Urinary leg or abdomen bag |
1,537 |
1,259 |
$7K |
| A6204 |
Composite drsg >16<=48 sq in |
111 |
84 |
$7K |
| L0621 |
Sio flex pelvic/sacr pre ots |
159 |
151 |
$7K |
| A4217 |
Sterile water/saline, 500 ml |
1,338 |
1,266 |
$7K |
| L1833 |
Ko adj jnt pos r sup pre ots |
22 |
13 |
$7K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
523 |
467 |
$6K |
| A4369 |
Skin barrier liquid per oz |
1,478 |
1,256 |
$4K |
| A5121 |
Solid skin barrier 6x6 |
46 |
38 |
$4K |
| A4455 |
Adhesive remover per ounce |
803 |
711 |
$2K |
| A4927 |
Non-sterile gloves |
633 |
556 |
$2K |
| A9999 |
Dme supply or accessory, nos |
377 |
362 |
$2K |
| A6587 |
Grad com wrap w straps foot |
122 |
61 |
$2K |
| S5199 |
Personal care item nos each |
328 |
294 |
$2K |
| A6257 |
Transparent film <= 16 sq in |
121 |
107 |
$1K |
| A4373 |
Skin barrier with flange |
40 |
36 |
$1K |
| A4364 |
Adhesive, liquid or equal |
168 |
142 |
$1K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
194 |
182 |
$1K |
| A4332 |
Lube sterile packet |
245 |
203 |
$794.11 |
| L2397 |
Suspension sleeve lower ext |
21 |
13 |
$669.73 |
| A4310 |
Insert tray w/o bag/cath |
157 |
126 |
$608.29 |
| A4338 |
Indwelling catheter latex |
198 |
159 |
$579.28 |
| A6011 |
Collagen gel/paste wound fil |
17 |
13 |
$467.62 |
| A6530 |
Compression stocking bk18-30 |
33 |
15 |
$406.63 |
| A4333 |
Urinary cath anchor device |
13 |
12 |
$38.20 |
| W4047 |
|
15 |
13 |
$0.00 |