| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
881 |
775 |
$89K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
901 |
787 |
$46K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
190 |
162 |
$16K |
| A4623 |
Tracheostomy, inner cannula |
205 |
175 |
$12K |
| A4452 |
Tape, waterproof, per 18 square inches |
440 |
390 |
$11K |
| A7526 |
Tracheostomy tube collar/holder, each |
175 |
150 |
$6K |
| A7503 |
Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each |
14 |
13 |
$1K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
53 |
43 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
12 |
12 |
$445.49 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
13 |
12 |
$414.91 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
32 |
25 |
$216.49 |