| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11043 |
|
40,702 |
14,585 |
$1.38M |
| 99308 |
|
63,790 |
30,564 |
$605K |
| 11042 |
|
45,785 |
18,505 |
$530K |
| 99309 |
|
23,911 |
14,075 |
$304K |
| 17250 |
|
17,243 |
6,090 |
$120K |
| A6021 |
Collagen dressing <=16 sq in |
1,754 |
1,185 |
$27K |
| A6196 |
Alginate dressing <=16 sq in |
11,714 |
7,071 |
$26K |
| 99307 |
|
4,626 |
3,364 |
$23K |
| 11044 |
|
665 |
218 |
$17K |
| A6010 |
Collagen based wound filler |
1,933 |
1,320 |
$13K |
| 99304 |
|
1,298 |
999 |
$11K |
| A6219 |
Gauze <= 16 sq in w/border |
16,754 |
9,666 |
$9K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,097 |
786 |
$6K |
| 97610 |
|
715 |
244 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
4,134 |
2,499 |
$3K |
| A6212 |
Foam drg <=16 sq in w/border |
2,564 |
1,739 |
$3K |
| 97597 |
|
173 |
82 |
$3K |
| A4452 |
Waterproof tape |
1,437 |
799 |
$2K |
| 99305 |
|
175 |
118 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,927 |
1,188 |
$2K |
| A6446 |
Conform band s w>=3" <5"/yd |
4,382 |
2,589 |
$2K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
831 |
583 |
$2K |
| 99310 |
Prolong nursin fac eval 15m |
78 |
57 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
1,770 |
1,133 |
$1K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
791 |
486 |
$1K |
| A6248 |
Hydrogel drsg gel filler |
737 |
501 |
$1K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
462 |
298 |
$373.45 |
| G0407 |
Inpt/tele follow up 25 |
161 |
87 |
$328.26 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
730 |
506 |
$288.77 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
282 |
194 |
$283.17 |
| G0406 |
Inpt/tele follow up 15 |
256 |
122 |
$254.10 |
| 11046 |
|
51 |
24 |
$249.63 |
| A4450 |
Non-waterproof tape |
147 |
95 |
$234.88 |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
74 |
50 |
$178.87 |
| A6216 |
Non-sterile gauze<=16 sq in |
407 |
247 |
$177.70 |
| A6203 |
Composite drsg <= 16 sq in |
98 |
72 |
$135.44 |
| 97607 |
|
45 |
14 |
$126.44 |
| A6445 |
Conform band s w <3"/yd |
206 |
141 |
$69.16 |
| G0426 |
Inpt/ed teleconsult50 |
21 |
14 |
$29.69 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
63 |
38 |
$0.00 |