| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
11,654 |
11,187 |
$26K |
| A4259 |
Lancets, per box of 100 |
10,369 |
10,029 |
$5K |
| A4256 |
Normal, low and high calibrator solution / chips |
7,604 |
7,392 |
$2K |
| A4258 |
Spring-powered device for lancet, each |
4,410 |
4,257 |
$982.66 |
| E0607 |
Home blood glucose monitor |
198 |
192 |
$604.78 |
| A4233 |
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
3,465 |
3,347 |
$499.45 |
| A4235 |
Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
948 |
909 |
$150.35 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
37 |
28 |
$120.26 |
| K0903 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
37 |
28 |
$104.54 |