| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
954 |
872 |
$23K |
| E0601 |
Continuous positive airway pressure (cpap) device |
324 |
299 |
$16K |
| A7031 |
Face mask interface, replacement for full face mask, each |
385 |
373 |
$14K |
| E0570 |
Nebulizer, with compressor |
307 |
278 |
$9K |
| 0002A |
|
208 |
208 |
$8K |
| 0001A |
|
210 |
209 |
$8K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
364 |
340 |
$7K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
78 |
64 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
996 |
961 |
$3K |
| 0064A |
|
29 |
29 |
$1K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
14 |
12 |
$913.77 |
| A7035 |
Headgear used with positive airway pressure device |
38 |
36 |
$682.68 |
| 0071A |
|
17 |
17 |
$680.00 |
| 0031A |
|
15 |
15 |
$600.00 |
| A4259 |
Lancets, per box of 100 |
125 |
118 |
$506.66 |
| 0004A |
|
13 |
13 |
$480.00 |
| 0124A |
|
12 |
12 |
$440.00 |
| 90686 |
|
38 |
38 |
$293.45 |
| A7037 |
Tubing used with positive airway pressure device |
51 |
51 |
$289.69 |
| A4215 |
Needle, sterile, any size, each |
12 |
12 |
$200.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
105 |
97 |
$161.78 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$117.65 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
39 |
39 |
$106.89 |
| 91301 |
|
31 |
29 |
$0.00 |
| 91307 |
|
25 |
17 |
$0.00 |
| 91300 |
|
301 |
274 |
$0.00 |
| 91312 |
|
12 |
12 |
$0.00 |