| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
270 |
249 |
$12K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
32 |
26 |
$2K |
| E0607 |
Home blood glucose monitor |
48 |
42 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
104 |
99 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
13 |
$1K |
| A4215 |
Needle, sterile, any size, each |
79 |
75 |
$1K |
| A4259 |
Lancets, per box of 100 |
192 |
175 |
$1K |
| S8490 |
Insulin syringes (100 syringes, any size) |
50 |
46 |
$906.34 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16 |
12 |
$383.07 |
| A4256 |
Normal, low and high calibrator solution / chips |
67 |
61 |
$292.56 |
| A4258 |
Spring-powered device for lancet, each |
28 |
25 |
$143.62 |