| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0001A |
|
3,303 |
3,278 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,022 |
1,002 |
$3K |
| 0002A |
|
914 |
884 |
$1K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
250 |
242 |
$648.20 |
| 0003A |
|
1,123 |
1,100 |
$506.00 |
| 0124A |
|
1,036 |
964 |
$472.00 |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
17 |
12 |
$330.91 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
77 |
68 |
$216.67 |
| 0011A |
|
53 |
51 |
$148.00 |
| 0031A |
|
54 |
54 |
$80.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
48 |
39 |
$49.06 |
| 0004A |
|
932 |
931 |
$40.00 |
| A4259 |
Lancets, per box of 100 |
260 |
249 |
$34.55 |
| 0051A |
|
275 |
271 |
$34.00 |
| 91300 |
|
3,932 |
3,277 |
$1.01 |
| 91312 |
|
56 |
51 |
$0.00 |
| 0013A |
|
18 |
15 |
$0.00 |
| 91303 |
|
53 |
53 |
$0.00 |
| G0333 |
Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
20 |
20 |
$0.00 |
| E0607 |
Home blood glucose monitor |
26 |
26 |
$0.00 |