| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
771 |
466 |
$129K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
639 |
589 |
$88K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
934 |
673 |
$30K |
| 0002A |
|
398 |
364 |
$14K |
| A4927 |
Gloves, non-sterile, per 100 |
404 |
370 |
$14K |
| 0001A |
|
516 |
471 |
$13K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
111 |
107 |
$13K |
| A4259 |
Lancets, per box of 100 |
413 |
298 |
$2K |
| 0072A |
|
19 |
19 |
$2K |
| A4554 |
Disposable underpads, all sizes |
16 |
13 |
$399.90 |
| 0124A |
|
12 |
12 |
$320.00 |
| 0003A |
|
27 |
27 |
$160.00 |
| 91320 |
|
12 |
12 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
12 |
$0.00 |
| 90677 |
|
12 |
12 |
$0.00 |
| 90480 |
|
12 |
12 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
12 |
12 |
$0.00 |