| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,605 |
2,564 |
$88K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
610 |
592 |
$69K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,495 |
1,470 |
$45K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
836 |
239 |
$43K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
267 |
266 |
$25K |
| E0570 |
Nebulizer, with compressor |
277 |
261 |
$25K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
168 |
163 |
$18K |
| A4335 |
Incontinence supply; miscellaneous |
3,021 |
2,981 |
$16K |
| S1015 |
Iv tubing extension set |
190 |
92 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
633 |
224 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
430 |
417 |
$716.25 |
| A7015 |
Aerosol mask, used with dme nebulizer |
454 |
441 |
$512.54 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
659 |
652 |
$419.94 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
163 |
85 |
$302.60 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
72 |
43 |
$190.10 |
| A4245 |
Alcohol wipes, per box |
168 |
138 |
$100.08 |
| A4248 |
Chlorhexidine containing antiseptic, 1 ml |
610 |
235 |
$37.89 |
| A4930 |
Gloves, sterile, per pair |
110 |
42 |
$28.65 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
84 |
51 |
$7.12 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
311 |
111 |
$6.98 |
| A4452 |
Tape, waterproof, per 18 square inches |
32 |
30 |
$4.77 |
| 0031A |
|
15 |
15 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 90688 |
|
14 |
14 |
$0.00 |
| A4649 |
Surgical supply; miscellaneous |
59 |
25 |
$0.00 |