| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
411 |
373 |
$30K |
| 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 |
420 |
318 |
$17K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
245 |
220 |
$2K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
15 |
13 |
$294.00 |
| A4245 |
Alcohol wipes, per box |
181 |
148 |
$128.72 |
| A4259 |
Lancets, per box of 100 |
32 |
31 |
$33.44 |