| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4623 |
Tracheostomy inner cannula |
371 |
293 |
$13K |
| A6197 |
Alginate drsg >16 <=48 sq in |
378 |
296 |
$13K |
| A6010 |
Collagen based wound filler |
266 |
211 |
$12K |
| A6196 |
Alginate dressing <=16 sq in |
900 |
772 |
$11K |
| A7526 |
Tracheostomy tube collar |
239 |
201 |
$4K |
| A4452 |
Waterproof tape |
510 |
430 |
$3K |
| A6203 |
Composite drsg <= 16 sq in |
168 |
139 |
$3K |
| A6199 |
Alginate drsg wound filler |
105 |
98 |
$1K |
| A6446 |
Conform band s w>=3" <5"/yd |
427 |
373 |
$1K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
232 |
206 |
$958.70 |
| A4314 |
Cath w/drainage 2-way latex |
148 |
123 |
$781.97 |
| A7521 |
Trach/laryn tube cuffed |
75 |
60 |
$557.02 |
| A4357 |
Bedside drainage bag |
305 |
255 |
$488.02 |
| A6212 |
Foam drg <=16 sq in w/border |
176 |
155 |
$448.10 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
176 |
148 |
$425.74 |
| A6231 |
Hydrogel dsg<=16 sq in |
58 |
43 |
$308.77 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
77 |
66 |
$257.20 |
| A6248 |
Hydrogel drsg gel filler |
199 |
168 |
$129.92 |
| A4333 |
Urinary cath anchor device |
67 |
61 |
$35.86 |
| A5120 |
Skin barrier, wipe or swab |
50 |
41 |
$20.37 |
| A4450 |
Non-waterproof tape |
37 |
31 |
$13.84 |
| A4334 |
Urinary cath leg strap |
28 |
25 |
$6.65 |
| A6402 |
Sterile gauze <= 16 sq in |
47 |
47 |
$0.00 |
| A4315 |
Cath w/drainage 2-way silcne |
32 |
30 |
$0.00 |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
16 |
14 |
$0.00 |
| A4629 |
Tracheostomy care kit |
26 |
26 |
$0.00 |