| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4215 |
Needle, sterile, any size, each |
3,140 |
3,030 |
$71K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
4,570 |
4,018 |
$62K |
| A4259 |
Lancets, per box of 100 |
2,927 |
2,853 |
$15K |
| A4245 |
Alcohol wipes, per box |
2,792 |
2,717 |
$14K |
| E0607 |
Home blood glucose monitor |
656 |
642 |
$11K |
| 0064A |
|
69 |
65 |
$2K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
81 |
81 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
78 |
78 |
$730.75 |
| 90686 |
|
44 |
44 |
$699.91 |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
59 |
51 |
$42.46 |
| 90480 |
|
249 |
248 |
$0.00 |
| 0134A |
|
148 |
94 |
$0.00 |
| 90674 |
|
72 |
71 |
$0.00 |
| 90656 |
|
30 |
30 |
$0.00 |
| 91306 |
|
12 |
12 |
$0.00 |
| 91322 |
|
182 |
181 |
$0.00 |
| 91313 |
|
148 |
94 |
$0.00 |
| 91320 |
|
67 |
67 |
$0.00 |