| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
14,088 |
13,811 |
$303K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,727 |
2,649 |
$216K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,427 |
1,411 |
$143K |
| B4100 |
Food thickener, administered orally, per ounce |
2,924 |
2,865 |
$121K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,012 |
992 |
$110K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
777 |
763 |
$95K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
981 |
964 |
$81K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,340 |
1,308 |
$48K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
301 |
297 |
$38K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
293 |
285 |
$25K |
| A4322 |
Irrigation syringe, bulb or piston, each |
252 |
195 |
$19K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,000 |
980 |
$16K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
165 |
159 |
$13K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
38 |
36 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
66 |
66 |
$2K |
| V2020 |
Frames, purchases |
27 |
27 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
22 |
12 |
$886.37 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
298 |
244 |
$830.13 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$720.00 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
34 |
25 |
$598.77 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
28 |
26 |
$21.29 |
| 90662 |
|
16 |
16 |
$0.00 |
| 90674 |
|
1,086 |
1,086 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
1,525 |
1,525 |
$0.00 |
| 90686 |
|
402 |
402 |
$0.00 |