| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Non-sterile gloves |
3,748 |
3,148 |
$274K |
| T2028 |
Special supply, nos waiver |
8,084 |
6,405 |
$226K |
| T4528 |
Adult size pull-on xl |
1,152 |
1,039 |
$176K |
| T4526 |
Adult size pull-on med |
1,434 |
1,216 |
$159K |
| B4035 |
Enteral feed supp pump per d |
814 |
680 |
$137K |
| T4527 |
Adult size pull-on lg |
818 |
671 |
$101K |
| L0621 |
Sio flex pelvic/sacr pre ots |
609 |
574 |
$49K |
| T4537 |
Reusable underpad bed size |
1,055 |
1,009 |
$47K |
| B4088 |
Gastro/jejuno tube, low-pro |
258 |
237 |
$44K |
| T4535 |
Disposable liner/shield/pad |
408 |
381 |
$41K |
| T4543 |
Adult disp brief/diap abv xl |
81 |
81 |
$21K |
| A6530 |
Compression stocking bk18-30 |
400 |
327 |
$19K |
| A4253 |
Blood glucose/reagent strips |
4,336 |
3,089 |
$18K |
| T4522 |
Adult size brief/diaper med |
136 |
126 |
$14K |
| T4530 |
Ped size brief/diaper lg |
136 |
111 |
$13K |
| T4541 |
Large disposable underpad |
266 |
254 |
$13K |
| T2029 |
Special med equip, noswaiver |
52 |
28 |
$12K |
| L2630 |
Pelvic control band & belt u |
24 |
24 |
$7K |
| B4161 |
Ef ped hydrolyzed/amino acid |
14 |
12 |
$6K |
| A4215 |
Sterile needle |
193 |
173 |
$6K |
| T4523 |
Adult size brief/diaper lg |
47 |
37 |
$6K |
| T4532 |
Ped size pull-on lg |
27 |
24 |
$3K |
| T4525 |
Adult size pull-on sm |
14 |
14 |
$2K |
| E0570 |
Nebulizer with compression |
346 |
211 |
$2K |
| E0607 |
Blood glucose monitor home |
28 |
24 |
$736.27 |
| A4259 |
Lancets per box |
1,017 |
823 |
$530.24 |
| Q0513 |
Disp fee inhal drugs/30 days |
1,157 |
475 |
$232.18 |
| A4245 |
Alcohol wipes per box |
41 |
39 |
$58.38 |
| A4520 |
Incontinence garment anytype |
318 |
307 |
$0.00 |
| G0008 |
Admin influenza virus vac |
38 |
38 |
$0.00 |
| 90674 |
|
38 |
38 |
$0.00 |
| J7620 |
Albuterol ipratrop non-comp |
52 |
13 |
$0.00 |
| K1034 |
Covid test self-admn/collect |
16 |
12 |
$0.00 |