| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4157 |
Ef special metabolic inherit |
1,512 |
1,461 |
$1.10M |
| B4162 |
Ef ped specmetabolic inherit |
557 |
542 |
$325K |
| T4527 |
Adult size pull-on lg |
556 |
541 |
$61K |
| T4543 |
Adult disp brief/diap abv xl |
250 |
236 |
$41K |
| A4253 |
Blood glucose/reagent strips |
230 |
189 |
$30K |
| A4554 |
Disposable underpads |
489 |
471 |
$28K |
| B4153 |
Ef hydrolyzed/amino acids |
26 |
25 |
$7K |
| T4523 |
Adult size brief/diaper lg |
42 |
38 |
$5K |
| A7005 |
Nondisposable nebulizer set |
129 |
113 |
$3K |
| A4259 |
Lancets per box |
219 |
181 |
$2K |
| E0570 |
Nebulizer with compression |
18 |
16 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
125 |
112 |
$203.13 |
| B4158 |
Ef ped complete intact nut |
32 |
32 |
$0.00 |
| B4150 |
Ef complet w/intact nutrient |
28 |
28 |
$0.00 |