| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
52 |
38 |
$2K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
219 |
162 |
$1K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
23 |
14 |
$452.39 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
73 |
51 |
$250.72 |
| A4452 |
Tape, waterproof, per 18 square inches |
15 |
14 |
$78.76 |