| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
177 |
170 |
$94K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
204 |
194 |
$46K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
80 |
77 |
$33K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
236 |
227 |
$32K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
243 |
230 |
$11K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
92 |
89 |
$10K |
| A4452 |
Tape, waterproof, per 18 square inches |
355 |
346 |
$9K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
117 |
113 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
170 |
166 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
27 |
26 |
$239.23 |