| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
2,885 |
2,539 |
$115K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
595 |
533 |
$62K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
484 |
379 |
$62K |
| A4554 |
Disposable underpads, all sizes |
1,419 |
1,207 |
$59K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
416 |
361 |
$42K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
416 |
338 |
$41K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
334 |
276 |
$29K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
267 |
220 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
465 |
406 |
$9K |
| B9998 |
Noc for enteral supplies |
667 |
272 |
$4K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
749 |
360 |
$2K |
| E0570 |
Nebulizer, with compressor |
35 |
26 |
$2K |
| A4259 |
Lancets, per box of 100 |
27 |
14 |
$16.69 |