| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
756 |
719 |
$61K |
| T4523 |
Adult size brief/diaper lg |
277 |
262 |
$44K |
| A6196 |
Alginate dressing <=16 sq in |
401 |
331 |
$41K |
| A6023 |
Collagen dressing >48 sq in |
135 |
107 |
$24K |
| A6212 |
Foam drg <=16 sq in w/border |
266 |
216 |
$19K |
| T4539 |
Reuse diaper/brief any size |
580 |
559 |
$19K |
| T4537 |
Reusable underpad bed size |
519 |
501 |
$14K |
| A6207 |
Contact layer >16<= 48 sq in |
299 |
243 |
$12K |
| A6233 |
Hydrogel dressing >48 sq in |
135 |
114 |
$12K |
| T4535 |
Disposable liner/shield/pad |
144 |
140 |
$10K |
| A4216 |
Sterile water/saline, 10 ml |
213 |
177 |
$7K |
| T4540 |
Reusable underpad chair size |
485 |
473 |
$7K |
| A6205 |
Composite drsg > 48 sq in |
94 |
76 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
233 |
203 |
$4K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
72 |
60 |
$4K |
| A6010 |
Collagen based wound filler |
31 |
26 |
$3K |
| E0570 |
Nebulizer with compression |
39 |
39 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
373 |
323 |
$3K |
| A6259 |
Transparent film > 48 sq in |
46 |
39 |
$2K |
| A4452 |
Waterproof tape |
164 |
136 |
$2K |
| A4450 |
Non-waterproof tape |
109 |
96 |
$2K |
| A4930 |
Sterile, gloves per pair |
118 |
101 |
$953.06 |
| A5120 |
Skin barrier, wipe or swab |
60 |
53 |
$552.30 |
| A4927 |
Non-sterile gloves |
154 |
131 |
$496.28 |
| A4245 |
Alcohol wipes per box |
44 |
38 |
$200.13 |