| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
2,605 |
2,564 |
$88K |
| T4527 |
Adult size pull-on lg |
610 |
592 |
$69K |
| T4535 |
Disposable liner/shield/pad |
1,495 |
1,470 |
$45K |
| A4305 |
Drug delivery system >=50 ml |
836 |
239 |
$43K |
| T4526 |
Adult size pull-on med |
267 |
266 |
$25K |
| E0570 |
Nebulizer with compression |
277 |
261 |
$25K |
| T4528 |
Adult size pull-on xl |
168 |
163 |
$18K |
| A4335 |
Incontinence supply |
3,021 |
2,981 |
$16K |
| S1015 |
Iv tubing extension set |
190 |
92 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
633 |
224 |
$1K |
| A7003 |
Nebulizer administration set |
430 |
417 |
$716.25 |
| A7015 |
Aerosol mask used w nebulize |
454 |
441 |
$512.54 |
| K1034 |
Covid test self-admn/collect |
659 |
652 |
$419.94 |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
163 |
85 |
$302.60 |
| A6258 |
Transparent film >16<=48 in |
72 |
43 |
$190.10 |
| A4245 |
Alcohol wipes per box |
168 |
138 |
$100.08 |
| A4248 |
Chlorhexidine antisept |
610 |
235 |
$37.89 |
| A4930 |
Sterile, gloves per pair |
110 |
42 |
$28.65 |
| A6402 |
Sterile gauze <= 16 sq in |
84 |
51 |
$7.12 |
| J1642 |
Inj heparin sodium per 10 u |
311 |
111 |
$6.98 |
| A4452 |
Waterproof tape |
32 |
30 |
$4.77 |
| 0031A |
|
15 |
15 |
$0.00 |
| G0008 |
Admin influenza virus vac |
14 |
14 |
$0.00 |
| 90688 |
|
14 |
14 |
$0.00 |
| A4649 |
Surgical supplies |
59 |
25 |
$0.00 |