| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,892 |
1,614 |
$93K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
1,162 |
595 |
$36K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
191 |
164 |
$21K |
| E0570 |
Nebulizer, with compressor |
177 |
147 |
$19K |
| 87428 |
|
243 |
197 |
$9K |
| 0013A |
|
30 |
29 |
$2K |
| 0011A |
|
18 |
16 |
$1K |
| 0012A |
|
16 |
15 |
$975.00 |
| 90674 |
|
28 |
27 |
$778.05 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
38 |
29 |
$367.14 |
| 90686 |
|
24 |
17 |
$283.84 |
| 91322 |
|
14 |
14 |
$133.39 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
259 |
252 |
$16.64 |
| 91301 |
|
69 |
65 |
$0.00 |
| 90480 |
|
13 |
13 |
$0.00 |