| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam drg <=16 sq in w/border |
1,230 |
926 |
$80K |
| A6196 |
Alginate dressing <=16 sq in |
772 |
565 |
$52K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,507 |
1,177 |
$22K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
638 |
469 |
$20K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
136 |
108 |
$9K |
| A4452 |
Waterproof tape |
1,009 |
806 |
$9K |
| A6402 |
Sterile gauze <= 16 sq in |
1,857 |
1,486 |
$8K |
| A6021 |
Collagen dressing <=16 sq in |
32 |
24 |
$5K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
13 |
13 |
$4K |
| A6197 |
Alginate drsg >16 <=48 sq in |
14 |
12 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
67 |
58 |
$2K |
| A4385 |
Ost skn barrier sld ext wear |
44 |
37 |
$1K |
| A6545 |
Grad com non-elastic bk surg |
51 |
38 |
$671.25 |
| A6253 |
Absorpt drg > 48 sq in w/o b |
15 |
13 |
$529.22 |
| A4450 |
Non-waterproof tape |
249 |
214 |
$399.61 |
| A6457 |
Tubular dressing |
51 |
45 |
$314.21 |
| A6216 |
Non-sterile gauze<=16 sq in |
31 |
24 |
$90.00 |
| A5120 |
Skin barrier, wipe or swab |
14 |
12 |
$55.75 |
| A4371 |
Skin barrier powder per oz |
13 |
12 |
$42.36 |