| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,744 |
3,175 |
$433K |
| A4927 |
Gloves, non-sterile, per 100 |
3,669 |
3,142 |
$68K |
| E0570 |
Nebulizer, with compressor |
473 |
422 |
$39K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
271 |
248 |
$5K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
12 |
12 |
$952.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
19 |
15 |
$900.10 |
| A4259 |
Lancets, per box of 100 |
18 |
15 |
$178.75 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$26.28 |