| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
554 |
465 |
$13K |
| 0002A |
|
79 |
71 |
$5K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
86 |
80 |
$5K |
| 0001A |
|
102 |
86 |
$4K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
765 |
672 |
$3K |
| K0001 |
Standard wheelchair |
252 |
248 |
$2K |
| 0011A |
|
159 |
153 |
$2K |
| 0012A |
|
137 |
133 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
62 |
52 |
$1K |
| 0064A |
|
96 |
87 |
$1K |
| 0071A |
|
16 |
16 |
$640.00 |
| 0072A |
|
15 |
15 |
$600.00 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
15 |
13 |
$573.82 |
| A4259 |
Lancets, per box of 100 |
73 |
63 |
$383.06 |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
1,175 |
1,021 |
$369.26 |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
889 |
836 |
$237.23 |
| 0031A |
|
15 |
15 |
$120.00 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
28 |
25 |
$3.59 |
| 91301 |
|
38 |
36 |
$0.27 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
15 |
15 |
$0.00 |