| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6021 |
Collagen dressing <=16 sq in |
7,818 |
7,259 |
$718K |
| A6196 |
Alginate dressing <=16 sq in |
13,792 |
12,933 |
$508K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,887 |
1,743 |
$225K |
| A6212 |
Foam drg <=16 sq in w/border |
8,397 |
7,774 |
$194K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
5,075 |
4,606 |
$160K |
| A6446 |
Conform band s w>=3" <5"/yd |
16,938 |
15,753 |
$152K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
5,078 |
4,765 |
$118K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
8,062 |
7,695 |
$110K |
| A4452 |
Waterproof tape |
13,662 |
12,974 |
$95K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
909 |
819 |
$74K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,869 |
1,815 |
$63K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,567 |
1,467 |
$48K |
| A6010 |
Collagen based wound filler |
581 |
497 |
$47K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
763 |
707 |
$44K |
| A6219 |
Gauze <= 16 sq in w/border |
7,327 |
6,855 |
$38K |
| A6402 |
Sterile gauze <= 16 sq in |
12,146 |
11,370 |
$35K |
| A4450 |
Non-waterproof tape |
6,026 |
5,603 |
$32K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
2,988 |
2,765 |
$30K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
970 |
931 |
$22K |
| A6248 |
Hydrogel drsg gel filler |
2,070 |
2,002 |
$20K |
| A6452 |
High compres band w>=3"<5"yd |
378 |
355 |
$17K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,072 |
1,031 |
$16K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
718 |
690 |
$13K |
| A6199 |
Alginate drsg wound filler |
345 |
333 |
$11K |
| A6454 |
Self-adher band w>=3" <5"/yd |
799 |
765 |
$9K |
| A6441 |
Pad band w>=3" <5"/yd |
632 |
583 |
$9K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
509 |
462 |
$7K |
| A6407 |
Packing strips, non-impreg |
93 |
89 |
$2K |
| A4623 |
Tracheostomy inner cannula |
183 |
180 |
$2K |
| A6261 |
Wound filler gel/paste /oz |
205 |
194 |
$2K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
112 |
106 |
$1K |
| A7526 |
Tracheostomy tube collar |
278 |
274 |
$1K |
| A4314 |
Cath w/drainage 2-way latex |
591 |
550 |
$1K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
12 |
12 |
$1K |
| A6450 |
Lt compres band >=5"/yd |
103 |
94 |
$1K |
| A6203 |
Composite drsg <= 16 sq in |
77 |
74 |
$898.18 |
| A4334 |
Urinary cath leg strap |
650 |
613 |
$489.02 |
| A6545 |
Grad com non-elastic bk surg |
18 |
14 |
$444.84 |
| A4357 |
Bedside drainage bag |
184 |
175 |
$396.12 |
| A4626 |
Tracheostomy cleaning brush |
94 |
62 |
$356.12 |
| A7521 |
Trach/laryn tube cuffed |
64 |
61 |
$298.68 |
| A9999 |
Dme supply or accessory, nos |
60 |
58 |
$201.88 |
| A6207 |
Contact layer >16<= 48 sq in |
12 |
12 |
$160.61 |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
14 |
14 |
$68.01 |
| A6403 |
Sterile gauze>16 <= 48 sq in |
12 |
12 |
$62.16 |
| A6457 |
Tubular dressing |
19 |
15 |
$7.96 |