| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,955 |
3,767 |
$54K |
| T4541 |
Incontinence product, disposable underpad, large, each |
519 |
461 |
$15K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
150 |
121 |
$12K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
80 |
77 |
$7K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
97 |
89 |
$4K |
| A4245 |
Alcohol wipes, per box |
1,198 |
1,115 |
$4K |
| A4259 |
Lancets, per box of 100 |
2,478 |
2,386 |
$3K |
| E0607 |
Home blood glucose monitor |
25 |
25 |
$2K |
| E0570 |
Nebulizer, with compressor |
253 |
234 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
52 |
51 |
$339.15 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
12 |
12 |
$337.68 |
| A4258 |
Spring-powered device for lancet, each |
28 |
27 |
$44.60 |