| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
1,434 |
857 |
$664K |
| A4239 |
Non-adju cgm supply allow |
5,341 |
4,306 |
$344K |
| K0553 |
Ther cgm supply allowance |
7,036 |
3,870 |
$303K |
| A4238 |
Adju cgm supply allowance |
727 |
524 |
$92K |
| E0570 |
Nebulizer with compression |
1,344 |
980 |
$24K |
| A4554 |
Disposable underpads |
1,253 |
918 |
$24K |
| A4351 |
Straight tip urine catheter |
333 |
213 |
$17K |
| K0554 |
Ther cgm receiver/monitor |
220 |
99 |
$11K |
| T4533 |
Youth size brief/diaper |
111 |
90 |
$9K |
| A6257 |
Transparent film <= 16 sq in |
1,671 |
877 |
$4K |
| T4523 |
Adult size brief/diaper lg |
19 |
13 |
$2K |
| E2102 |
Adju cgm receiver/monitor |
19 |
14 |
$2K |
| A4253 |
Blood glucose/reagent strips |
61 |
59 |
$2K |
| A4927 |
Non-sterile gloves |
246 |
154 |
$1K |
| K0003 |
Lightweight wheelchair |
168 |
103 |
$1K |
| A7005 |
Nondisposable nebulizer set |
113 |
97 |
$890.07 |
| E2103 |
Non-adju cgm receiver/mon |
21 |
12 |
$826.90 |
| A4332 |
Lube sterile packet |
18 |
13 |
$485.62 |
| A4259 |
Lancets per box |
58 |
56 |
$250.56 |
| S8490 |
100 insulin syringes |
14 |
13 |
$245.70 |
| A7015 |
Aerosol mask used w nebulize |
136 |
112 |
$108.51 |
| A4245 |
Alcohol wipes per box |
44 |
43 |
$84.00 |
| A7003 |
Nebulizer administration set |
22 |
14 |
$17.51 |