| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,543 |
1,510 |
$225K |
| A4927 |
Gloves, non-sterile, per 100 |
5,749 |
5,631 |
$82K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,342 |
3,174 |
$29K |
| A4259 |
Lancets, per box of 100 |
1,985 |
1,893 |
$3K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
244 |
213 |
$1K |
| A4554 |
Disposable underpads, all sizes |
14 |
14 |
$612.00 |
| E0607 |
Home blood glucose monitor |
41 |
41 |
$338.18 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
78 |
72 |
$192.68 |
| A4256 |
Normal, low and high calibrator solution / chips |
116 |
115 |
$120.70 |
| A4258 |
Spring-powered device for lancet, each |
80 |
79 |
$110.98 |
| A4245 |
Alcohol wipes, per box |
12 |
12 |
$32.98 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
15 |
14 |
$21.96 |