| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
556 |
546 |
$56K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
484 |
484 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
264 |
264 |
$13K |
| E0570 |
Nebulizer, with compressor |
242 |
241 |
$12K |
| 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 |
259 |
130 |
$10K |
| T4541 |
Incontinence product, disposable underpad, large, each |
196 |
195 |
$8K |
| 99607 |
|
98 |
98 |
$6K |
| 99605 |
|
91 |
91 |
$4K |
| 98960 |
|
84 |
81 |
$2K |
| A4554 |
Disposable underpads, all sizes |
54 |
52 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
523 |
513 |
$2K |
| 90653 |
|
39 |
39 |
$1K |
| 99201 |
|
29 |
29 |
$807.93 |
| 90694 |
|
12 |
12 |
$506.04 |
| 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 |
26 |
13 |
$503.88 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$411.60 |
| 90674 |
|
15 |
15 |
$358.80 |
| A4259 |
Lancets, per box of 100 |
218 |
218 |
$108.30 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |