| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Non-sterile gloves |
14,088 |
13,811 |
$303K |
| B4150 |
Ef complet w/intact nutrient |
2,727 |
2,649 |
$216K |
| T4527 |
Adult size pull-on lg |
1,427 |
1,411 |
$143K |
| B4100 |
Food thickener oral |
2,924 |
2,865 |
$121K |
| T4523 |
Adult size brief/diaper lg |
1,012 |
992 |
$110K |
| T4528 |
Adult size pull-on xl |
777 |
763 |
$95K |
| T4526 |
Adult size pull-on med |
981 |
964 |
$81K |
| T4541 |
Large disposable underpad |
1,340 |
1,308 |
$48K |
| T4524 |
Adult size brief/diaper xl |
301 |
297 |
$38K |
| T4522 |
Adult size brief/diaper med |
293 |
285 |
$25K |
| A4322 |
Irrigation syringe |
252 |
195 |
$19K |
| T4537 |
Reusable underpad bed size |
1,000 |
980 |
$16K |
| B4152 |
Ef calorie dense>/=1.5kcal |
165 |
159 |
$13K |
| B4154 |
Ef spec metabolic noninherit |
38 |
36 |
$4K |
| 99213 |
|
66 |
66 |
$2K |
| V2020 |
Vision svcs frames purchases |
27 |
27 |
$2K |
| B4088 |
Gastro/jejuno tube, low-pro |
22 |
12 |
$886.37 |
| A6402 |
Sterile gauze <= 16 sq in |
298 |
244 |
$830.13 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
13 |
13 |
$720.00 |
| B4087 |
Gastro/jejuno tube, std |
34 |
25 |
$598.77 |
| A4253 |
Blood glucose/reagent strips |
28 |
26 |
$21.29 |
| 90662 |
|
16 |
16 |
$0.00 |
| 90674 |
|
1,086 |
1,086 |
$0.00 |
| G0008 |
Admin influenza virus vac |
1,525 |
1,525 |
$0.00 |
| 90686 |
|
402 |
402 |
$0.00 |