| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
5,730 |
3,703 |
$211K |
| A6010 |
Collagen based wound filler |
168 |
140 |
$98K |
| A4450 |
Non-waterproof tape |
284 |
231 |
$87K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
220 |
189 |
$77K |
| A6454 |
Self-adher band w>=3" <5"/yd |
160 |
136 |
$68K |
| A6449 |
Lt compres band >=3" <5"/yd |
97 |
81 |
$51K |
| 99204 |
|
631 |
559 |
$50K |
| 93922 |
|
1,002 |
895 |
$49K |
| 99215 |
Prolong outpt/office vis |
677 |
450 |
$35K |
| A6250 |
Skin seal protect moisturizr |
55 |
44 |
$34K |
| 76937 |
|
97 |
87 |
$32K |
| 99213 |
|
1,340 |
1,033 |
$29K |
| A6446 |
Conform band s w>=3" <5"/yd |
19 |
17 |
$16K |
| A6197 |
Alginate drsg >16 <=48 sq in |
36 |
26 |
$10K |
| 11042 |
|
202 |
151 |
$10K |
| 97597 |
|
155 |
103 |
$8K |
| 36005 |
|
77 |
51 |
$7K |
| 93971 |
|
93 |
85 |
$7K |
| 99205 |
Prolong outpt/office vis |
98 |
84 |
$6K |
| A6196 |
Alginate dressing <=16 sq in |
36 |
30 |
$5K |
| 99203 |
|
107 |
94 |
$5K |
| 29581 |
|
204 |
111 |
$5K |
| 99212 |
|
257 |
200 |
$4K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
19 |
15 |
$4K |
| 99310 |
Prolong nursin fac eval 15m |
45 |
35 |
$3K |
| 93990 |
|
40 |
37 |
$3K |
| 15271 |
|
146 |
49 |
$3K |
| 99309 |
|
88 |
67 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
25 |
22 |
$2K |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
19 |
13 |
$2K |
| 97598 |
|
36 |
27 |
$2K |
| 75820 |
|
14 |
12 |
$1K |
| 99305 |
|
47 |
42 |
$997.62 |
| 99306 |
Prolong nursin fac eval 15m |
15 |
13 |
$902.09 |
| 99222 |
|
29 |
24 |
$791.08 |
| A4246 |
Betadine/phisohex solution |
23 |
20 |
$766.13 |
| 99308 |
|
58 |
43 |
$318.54 |
| 96372 |
|
30 |
15 |
$38.35 |
| J0696 |
Ceftriaxone sodium injection |
36 |
16 |
$7.15 |
| A2002 |
Mirragen adv wnd mat per sq |
84 |
46 |
$0.00 |