| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,059 |
911 |
$53K |
| A4670 |
Automatic blood pressure monitor |
721 |
637 |
$40K |
| A4927 |
Gloves, non-sterile, per 100 |
1,116 |
961 |
$11K |
| E1639 |
Scale, each |
161 |
130 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12 |
12 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
90 |
73 |
$871.97 |
| 90686 |
|
40 |
34 |
$542.36 |
| 90688 |
|
50 |
47 |
$384.30 |
| G0008 |
Administration of influenza virus vaccine |
38 |
38 |
$0.00 |
| 90694 |
|
14 |
14 |
$0.00 |