| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
54 |
51 |
$3K |
| A6266 |
Impreg gauze no h20/sal/yard |
13 |
12 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
26 |
26 |
$1K |
| A6449 |
Lt compres band >=3" <5"/yd |
13 |
12 |
$476.95 |
| A6446 |
Conform band s w>=3" <5"/yd |
66 |
65 |
$410.02 |
| A6402 |
Sterile gauze <= 16 sq in |
136 |
131 |
$199.67 |
| A4450 |
Non-waterproof tape |
56 |
55 |
$139.19 |
| A6222 |
Gauze <=16 in no w/sal w/o b |
15 |
14 |
$136.10 |
| A6216 |
Non-sterile gauze<=16 sq in |
28 |
27 |
$81.61 |
| A6454 |
Self-adher band w>=3" <5"/yd |
12 |
12 |
$15.60 |