| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
2,076 |
1,920 |
$84K |
| A4554 |
Disposable underpads, all sizes |
1,190 |
1,114 |
$70K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
424 |
399 |
$63K |
| 0012A |
|
434 |
222 |
$10K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
55 |
51 |
$8K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
26 |
24 |
$3K |
| 0064A |
|
172 |
73 |
$3K |
| 0011A |
|
297 |
111 |
$2K |
| 0134A |
|
73 |
36 |
$1K |
| E0570 |
Nebulizer, with compressor |
97 |
57 |
$1K |
| 90471 |
|
191 |
95 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
513 |
445 |
$827.79 |
| 90686 |
|
33 |
26 |
$414.92 |
| 90674 |
|
47 |
22 |
$362.24 |
| 90688 |
|
53 |
22 |
$279.75 |
| 91301 |
|
839 |
395 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
14 |
14 |
$0.00 |
| A4259 |
Lancets, per box of 100 |
34 |
33 |
$0.00 |
| 91313 |
|
72 |
35 |
$0.00 |