| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
950 |
648 |
$27K |
| A4335 |
Incontinence supply; miscellaneous |
740 |
621 |
$19K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
160 |
157 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
33 |
26 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
41 |
39 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
108 |
64 |
$2K |
| 0124A |
|
46 |
46 |
$0.00 |
| 90694 |
|
46 |
46 |
$0.00 |
| 0012A |
|
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
53 |
53 |
$0.00 |