| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4623 |
Tracheostomy, inner cannula |
371 |
293 |
$13K |
| 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 |
378 |
296 |
$13K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
266 |
211 |
$12K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
900 |
772 |
$11K |
| A7526 |
Tracheostomy tube collar/holder, each |
239 |
201 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
510 |
430 |
$3K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
168 |
139 |
$3K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
105 |
98 |
$1K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
427 |
373 |
$1K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
232 |
206 |
$958.70 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
148 |
123 |
$781.97 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
75 |
60 |
$557.02 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
305 |
255 |
$488.02 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
176 |
155 |
$448.10 |
| 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 |
176 |
148 |
$425.74 |
| A6231 |
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing |
58 |
43 |
$308.77 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
77 |
66 |
$257.20 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
199 |
168 |
$129.92 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
67 |
61 |
$35.86 |
| A5120 |
Skin barrier, wipes or swabs, each |
50 |
41 |
$20.37 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
37 |
31 |
$13.84 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
28 |
25 |
$6.65 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
47 |
47 |
$0.00 |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
32 |
30 |
$0.00 |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
16 |
14 |
$0.00 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
26 |
26 |
$0.00 |