| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,109 |
855 |
$80K |
| 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 |
640 |
410 |
$29K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
244 |
213 |
$21K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
85 |
75 |
$8K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
236 |
181 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
49 |
38 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
33 |
29 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
157 |
141 |
$660.89 |
| 0002A |
|
457 |
457 |
$449.31 |
| 90662 |
|
126 |
121 |
$264.25 |
| 0001A |
|
481 |
476 |
$235.41 |
| 0004A |
|
66 |
66 |
$37.25 |
| 0051A |
|
209 |
209 |
$10.36 |
| 0124A |
|
202 |
202 |
$2.22 |
| 0003A |
|
178 |
154 |
$0.00 |
| M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring |
21 |
16 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
147 |
142 |
$0.00 |