| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
573 |
557 |
$20K |
| A4335 |
Incontinence supply; miscellaneous |
1,048 |
1,044 |
$6K |
| 0002A |
|
56 |
52 |
$751.02 |
| 0001A |
|
59 |
51 |
$404.02 |
| 0011A |
|
25 |
25 |
$283.49 |
| 0012A |
|
12 |
12 |
$196.67 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
14 |
13 |
$46.62 |
| 0003A |
|
19 |
18 |
$40.00 |
| 90756 |
|
32 |
32 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
111 |
111 |
$0.00 |
| 90674 |
|
43 |
43 |
$0.00 |
| A9270 |
Non-covered item or service |
26 |
26 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
15 |
15 |
$0.00 |