| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
538 |
381 |
$23K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
260 |
172 |
$12K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
222 |
143 |
$8K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
105 |
66 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
397 |
335 |
$1K |
| A4259 |
Lancets, per box of 100 |
26 |
26 |
$3.72 |
| G0008 |
Administration of influenza virus vaccine |
142 |
142 |
$2.80 |
| 0004A |
|
14 |
14 |
$0.00 |
| 0124A |
|
36 |
36 |
$0.00 |
| 90694 |
|
69 |
69 |
$0.00 |
| 0064A |
|
89 |
89 |
$0.00 |
| 0011A |
|
24 |
24 |
$0.00 |
| 0012A |
|
17 |
17 |
$0.00 |
| 90674 |
|
25 |
25 |
$0.00 |
| 90686 |
|
20 |
20 |
$0.00 |