| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
5,995 |
4,532 |
$1.21M |
| A6197 |
Alginate drsg >16 <=48 sq in |
2,974 |
2,216 |
$1.16M |
| A6021 |
Collagen dressing <=16 sq in |
2,975 |
2,345 |
$948K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
7,147 |
5,621 |
$666K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
6,386 |
5,248 |
$619K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,358 |
1,133 |
$529K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,139 |
1,717 |
$485K |
| A6196 |
Alginate dressing <=16 sq in |
2,276 |
1,781 |
$361K |
| A4385 |
Ost skn barrier sld ext wear |
3,317 |
2,942 |
$277K |
| A4351 |
Straight tip urine catheter |
2,258 |
2,004 |
$275K |
| A6446 |
Conform band s w>=3" <5"/yd |
6,943 |
5,671 |
$247K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,628 |
1,338 |
$215K |
| T4534 |
Youth size pull-on |
1,583 |
1,422 |
$207K |
| A4452 |
Waterproof tape |
10,392 |
8,471 |
$206K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,883 |
1,565 |
$186K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,761 |
1,618 |
$170K |
| A4394 |
Ostomy pouch liq deodorant |
4,644 |
4,173 |
$132K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
2,009 |
1,679 |
$123K |
| A6402 |
Sterile gauze <= 16 sq in |
7,861 |
6,414 |
$122K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,795 |
1,445 |
$105K |
| A4353 |
Intermittent urinary cath |
152 |
131 |
$94K |
| A4456 |
Adhesive remover, wipes |
5,107 |
4,569 |
$88K |
| A6240 |
Hydrocolld drg filler paste |
876 |
721 |
$79K |
| A5063 |
Drain ostomy pouch w/flange |
1,563 |
1,385 |
$77K |
| A6454 |
Self-adher band w>=3" <5"/yd |
2,054 |
1,728 |
$71K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
270 |
197 |
$69K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
895 |
803 |
$66K |
| A4425 |
Ost pch drain for barrier fl |
1,069 |
961 |
$63K |
| A6250 |
Skin seal protect moisturizr |
2,409 |
1,985 |
$61K |
| A4927 |
Non-sterile gloves |
3,452 |
2,935 |
$56K |
| A4362 |
Solid skin barrier |
955 |
830 |
$49K |
| A5120 |
Skin barrier, wipe or swab |
7,673 |
6,634 |
$48K |
| A6207 |
Contact layer >16<= 48 sq in |
509 |
411 |
$48K |
| T4525 |
Adult size pull-on sm |
287 |
267 |
$34K |
| T4531 |
Ped size pull-on sm/med |
233 |
157 |
$24K |
| A4407 |
Ext wear ost skn barr <=4sq" |
163 |
145 |
$23K |
| A4406 |
Pectin based ostomy paste |
1,922 |
1,731 |
$23K |
| A4357 |
Bedside drainage bag |
1,834 |
1,648 |
$17K |
| A6260 |
Wound cleanser any type/size |
2,862 |
2,220 |
$17K |
| A6457 |
Tubular dressing |
625 |
491 |
$15K |
| A6441 |
Pad band w>=3" <5"/yd |
587 |
477 |
$13K |
| T4541 |
Large disposable underpad |
496 |
422 |
$12K |
| A6248 |
Hydrogel drsg gel filler |
202 |
155 |
$11K |
| A6219 |
Gauze <= 16 sq in w/border |
506 |
427 |
$10K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,152 |
842 |
$9K |
| A6258 |
Transparent film >16<=48 in |
78 |
67 |
$9K |
| A4450 |
Non-waterproof tape |
2,277 |
1,841 |
$8K |
| A6199 |
Alginate drsg wound filler |
78 |
58 |
$8K |
| A4432 |
Os pch urine w bar/fange/tap |
167 |
152 |
$8K |
| A4371 |
Skin barrier powder per oz |
2,621 |
2,354 |
$6K |
| A4367 |
Ostomy belt |
724 |
652 |
$5K |
| A6445 |
Conform band s w <3"/yd |
132 |
115 |
$3K |
| A4402 |
Lubricant per ounce |
578 |
522 |
$3K |
| B4035 |
Enteral feed supp pump per d |
28 |
24 |
$2K |
| T4530 |
Ped size brief/diaper lg |
19 |
12 |
$2K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
16 |
15 |
$2K |
| A4320 |
Irrigation tray |
52 |
39 |
$1K |
| A4332 |
Lube sterile packet |
156 |
138 |
$1K |
| A6453 |
Self-adher band w <3"/yd |
21 |
14 |
$530.20 |