| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,001 |
1,001 |
$51K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
198 |
198 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
482 |
472 |
$2K |
| A4259 |
Lancets, per box of 100 |
187 |
186 |
$54.93 |
| 90480 |
|
42 |
42 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
53 |
53 |
$0.00 |
| 90694 |
|
23 |
23 |
$0.00 |
| 90653 |
|
23 |
23 |
$0.00 |
| 91320 |
|
41 |
41 |
$0.00 |
| 90662 |
|
45 |
45 |
$0.00 |