| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,214 |
810 |
$89K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
340 |
281 |
$24K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
309 |
232 |
$20K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
56 |
55 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
42 |
38 |
$1K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
15 |
12 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
17 |
13 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
228 |
211 |
$647.08 |
| 0134A |
|
120 |
120 |
$540.65 |
| 90686 |
|
187 |
186 |
$306.02 |
| 91322 |
|
287 |
281 |
$291.84 |
| G0008 |
Administration of influenza virus vaccine |
395 |
385 |
$254.99 |
| 90662 |
|
192 |
184 |
$146.80 |
| 90480 |
|
285 |
279 |
$122.72 |
| 0124A |
|
28 |
28 |
$111.76 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
15 |
15 |
$72.60 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
19 |
12 |
$26.55 |
| 0064A |
|
41 |
41 |
$0.00 |
| 90677 |
|
14 |
13 |
$0.00 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
97 |
95 |
$0.00 |