| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
6,705 |
5,784 |
$738K |
| K0553 |
Ther cgm supply allowance |
2,039 |
1,877 |
$297K |
| E2103 |
Non-adju cgm receiver/mon |
395 |
328 |
$55K |
| K0554 |
Ther cgm receiver/monitor |
188 |
181 |
$40K |
| A6446 |
Conform band s w>=3" <5"/yd |
870 |
795 |
$22K |
| A6196 |
Alginate dressing <=16 sq in |
87 |
78 |
$12K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
229 |
197 |
$10K |
| A6402 |
Sterile gauze <= 16 sq in |
983 |
912 |
$9K |
| A6212 |
Foam drg <=16 sq in w/border |
33 |
30 |
$4K |
| A6021 |
Collagen dressing <=16 sq in |
12 |
12 |
$4K |
| A4452 |
Waterproof tape |
282 |
247 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
18 |
12 |
$81.13 |
| A4450 |
Non-waterproof tape |
12 |
12 |
$42.72 |