| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
3,748 |
3,148 |
$274K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
8,084 |
6,405 |
$226K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,152 |
1,039 |
$176K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,434 |
1,216 |
$159K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
814 |
680 |
$137K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
818 |
671 |
$101K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
609 |
574 |
$49K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,055 |
1,009 |
$47K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
258 |
237 |
$44K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
408 |
381 |
$41K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
81 |
81 |
$21K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
400 |
327 |
$19K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
4,336 |
3,089 |
$18K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
136 |
126 |
$14K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
136 |
111 |
$13K |
| T4541 |
Incontinence product, disposable underpad, large, each |
266 |
254 |
$13K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
52 |
28 |
$12K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
24 |
24 |
$7K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
14 |
12 |
$6K |
| A4215 |
Needle, sterile, any size, each |
193 |
173 |
$6K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
47 |
37 |
$6K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
27 |
24 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
14 |
14 |
$2K |
| E0570 |
Nebulizer, with compressor |
346 |
211 |
$2K |
| E0607 |
Home blood glucose monitor |
28 |
24 |
$736.27 |
| A4259 |
Lancets, per box of 100 |
1,017 |
823 |
$530.24 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
1,157 |
475 |
$232.18 |
| A4245 |
Alcohol wipes, per box |
41 |
39 |
$58.38 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
318 |
307 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
38 |
38 |
$0.00 |
| 90674 |
|
38 |
38 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
52 |
13 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
16 |
12 |
$0.00 |