| Code | Description | Claims | Beneficiaries | Total Paid |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,366 |
1,364 |
$186K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,022 |
1,017 |
$142K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,759 |
2,759 |
$137K |
| A9150 |
Non-prescription drugs |
3,517 |
329 |
$115K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
598 |
598 |
$99K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,881 |
1,880 |
$79K |
| A4927 |
Gloves, non-sterile, per 100 |
4,500 |
4,494 |
$65K |
| 91322 |
|
94 |
84 |
$8K |
| 91320 |
|
46 |
46 |
$5K |
| 90674 |
|
115 |
104 |
$4K |
| 90756 |
|
99 |
91 |
$4K |
| 90677 |
|
15 |
14 |
$3K |
| 0064A |
|
120 |
108 |
$3K |
| 90658 |
|
58 |
58 |
$2K |
| 0124A |
|
47 |
45 |
$1K |
| 0011A |
|
36 |
31 |
$1K |
| 0001A |
|
28 |
28 |
$954.00 |
| 0134A |
|
45 |
43 |
$915.84 |
| 0012A |
|
34 |
22 |
$839.52 |
| 0002A |
|
12 |
12 |
$457.92 |
| A4259 |
Lancets, per box of 100 |
60 |
53 |
$22.30 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
352 |
248 |
$14.97 |
| G0008 |
Administration of influenza virus vaccine |
19 |
19 |
$0.00 |
| 90480 |
|
27 |
27 |
$0.00 |