| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
6,528 |
5,950 |
$264K |
| A6010 |
Collagen based wound filler |
2,555 |
2,359 |
$244K |
| A6197 |
Alginate drsg >16 <=48 sq in |
2,308 |
2,109 |
$175K |
| A4623 |
Tracheostomy inner cannula |
1,433 |
1,355 |
$60K |
| A6203 |
Composite drsg <= 16 sq in |
4,377 |
3,892 |
$57K |
| A6212 |
Foam drg <=16 sq in w/border |
2,949 |
2,669 |
$51K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,929 |
2,437 |
$37K |
| A4452 |
Waterproof tape |
4,049 |
3,527 |
$36K |
| A6021 |
Collagen dressing <=16 sq in |
607 |
541 |
$33K |
| A7526 |
Tracheostomy tube collar |
1,197 |
1,129 |
$31K |
| A6446 |
Conform band s w>=3" <5"/yd |
4,688 |
4,087 |
$30K |
| A6199 |
Alginate drsg wound filler |
756 |
708 |
$26K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
730 |
632 |
$10K |
| A4333 |
Urinary cath anchor device |
2,147 |
1,924 |
$9K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,740 |
1,572 |
$9K |
| A6449 |
Lt compres band >=3" <5"/yd |
247 |
199 |
$8K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
637 |
568 |
$8K |
| A4314 |
Cath w/drainage 2-way latex |
2,285 |
2,060 |
$7K |
| A4357 |
Bedside drainage bag |
4,759 |
4,354 |
$7K |
| A4315 |
Cath w/drainage 2-way silcne |
1,077 |
964 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
967 |
868 |
$2K |
| A7521 |
Trach/laryn tube cuffed |
172 |
169 |
$2K |
| A6454 |
Self-adher band w>=3" <5"/yd |
86 |
77 |
$2K |
| A6248 |
Hydrogel drsg gel filler |
1,061 |
980 |
$2K |
| A4320 |
Irrigation tray |
180 |
174 |
$2K |
| A4450 |
Non-waterproof tape |
424 |
335 |
$1K |
| A6231 |
Hydrogel dsg<=16 sq in |
96 |
91 |
$1K |
| A4334 |
Urinary cath leg strap |
1,650 |
1,520 |
$1K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
147 |
130 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
326 |
270 |
$943.76 |
| A4456 |
Adhesive remover, wipes |
624 |
547 |
$862.20 |
| A4358 |
Urinary leg or abdomen bag |
708 |
609 |
$742.23 |
| A6219 |
Gauze <= 16 sq in w/border |
248 |
233 |
$652.72 |
| A4394 |
Ostomy pouch liq deodorant |
121 |
103 |
$417.64 |
| A5063 |
Drain ostomy pouch w/flange |
105 |
90 |
$268.85 |
| A4409 |
Ost skn barr convex <=4 sq i |
14 |
12 |
$201.18 |
| A9999 |
Dme supply or accessory, nos |
15 |
12 |
$160.68 |
| A4362 |
Solid skin barrier |
15 |
12 |
$149.74 |
| A6251 |
Absorpt drg <=16 sq in w/o b |
27 |
24 |
$131.93 |
| A5131 |
Appliance cleaner |
89 |
82 |
$4.90 |
| A4629 |
Tracheostomy care kit |
206 |
206 |
$0.00 |
| A4371 |
Skin barrier powder per oz |
15 |
12 |
$0.00 |
| A4406 |
Pectin based ostomy paste |
61 |
52 |
$0.00 |