| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
406 |
371 |
$39K |
| T4541 |
Incontinence product, disposable underpad, large, each |
519 |
510 |
$24K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
148 |
139 |
$21K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
65 |
64 |
$8K |
| 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 |
30 |
24 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$2K |
| 99605 |
|
30 |
30 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
26 |
24 |
$737.99 |
| 99606 |
|
22 |
15 |
$691.02 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
149 |
136 |
$523.57 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
16 |
14 |
$164.64 |
| 91322 |
|
25 |
25 |
$136.98 |
| 90686 |
|
91 |
91 |
$120.68 |
| 0011A |
|
61 |
61 |
$52.28 |
| 90480 |
|
25 |
25 |
$41.34 |
| 0124A |
|
53 |
49 |
$40.50 |
| G0008 |
Administration of influenza virus vaccine |
198 |
198 |
$0.00 |
| 90694 |
|
12 |
12 |
$0.00 |
| 0012A |
|
54 |
54 |
$0.00 |
| 91301 |
|
33 |
33 |
$0.00 |
| 90662 |
|
12 |
12 |
$0.00 |
| 0013A |
|
62 |
62 |
$0.00 |
| 90682 |
|
15 |
15 |
$0.00 |