| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
1,217 |
1,038 |
$30K |
| A6212 |
Foam drg <=16 sq in w/border |
1,134 |
916 |
$14K |
| A6010 |
Collagen based wound filler |
353 |
242 |
$8K |
| A6446 |
Conform band s w>=3" <5"/yd |
981 |
811 |
$4K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
189 |
166 |
$4K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
311 |
279 |
$3K |
| A6219 |
Gauze <= 16 sq in w/border |
584 |
506 |
$2K |
| A6021 |
Collagen dressing <=16 sq in |
12 |
12 |
$2K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
142 |
112 |
$908.86 |
| A6199 |
Alginate drsg wound filler |
23 |
12 |
$685.58 |
| A4450 |
Non-waterproof tape |
881 |
731 |
$479.13 |