| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,550 |
1,461 |
$232K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,443 |
1,357 |
$213K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,385 |
1,331 |
$197K |
| A4927 |
Gloves, non-sterile, per 100 |
6,432 |
5,971 |
$181K |
| 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 |
1,337 |
1,230 |
$110K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,197 |
2,976 |
$75K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,130 |
1,075 |
$72K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
38 |
32 |
$1K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
18 |
18 |
$826.66 |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
14 |
14 |
$617.68 |
| A4930 |
Gloves, sterile, per pair |
42 |
42 |
$107.92 |
| 0124A |
|
97 |
97 |
$74.62 |
| 90694 |
|
74 |
74 |
$66.42 |
| 0064A |
|
131 |
131 |
$37.99 |
| 0013A |
|
29 |
29 |
$37.31 |
| 90674 |
|
80 |
80 |
$32.95 |
| 90756 |
|
12 |
12 |
$31.94 |
| G0008 |
Administration of influenza virus vaccine |
295 |
295 |
$23.61 |
| 0012A |
|
51 |
51 |
$9.20 |
| 0011A |
|
86 |
86 |
$4.40 |
| 0134A |
|
29 |
29 |
$1.48 |
| 0004A |
|
26 |
26 |
$0.74 |
| G0009 |
Administration of pneumococcal vaccine |
33 |
33 |
$0.00 |
| 90677 |
|
33 |
33 |
$0.00 |
| 90480 |
|
237 |
237 |
$0.00 |
| 91320 |
|
85 |
85 |
$0.00 |
| 91322 |
|
149 |
149 |
$0.00 |
| 90661 |
|
23 |
23 |
$0.00 |
| 0003A |
|
49 |
49 |
$0.00 |
| 90653 |
|
45 |
45 |
$0.00 |