| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
75 |
51 |
$327.70 |
| A5120 |
Skin barrier, wipes or swabs, each |
234 |
138 |
$145.21 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
40 |
38 |
$133.16 |
| A4456 |
Adhesive remover, wipes, any type, each |
48 |
40 |
$45.64 |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
14 |
12 |
$22.92 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
29 |
24 |
$8.10 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
128 |
107 |
$4.64 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
92 |
81 |
$4.54 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
195 |
145 |
$2.28 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
87 |
65 |
$1.30 |
| A4452 |
Tape, waterproof, per 18 square inches |
83 |
73 |
$0.36 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
12 |
$0.00 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
16 |
12 |
$0.00 |