| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
320 |
279 |
$15K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
135 |
84 |
$6K |
| T4541 |
Incontinence product, disposable underpad, large, each |
95 |
88 |
$6K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
132 |
64 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
248 |
169 |
$4K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
134 |
64 |
$4K |
| K0001 |
Standard wheelchair |
398 |
330 |
$3K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
13 |
13 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
36 |
28 |
$84.44 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
14 |
14 |
$12.78 |
| G0008 |
Administration of influenza virus vaccine |
58 |
54 |
$0.00 |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
58 |
54 |
$0.00 |