| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
151 |
145 |
$16K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
139 |
130 |
$13K |
| A9150 |
Non-prescription drugs |
696 |
691 |
$12K |
| 90674 |
|
932 |
926 |
$9K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,304 |
2,031 |
$8K |
| G9012 |
Other specified case management service not elsewhere classified |
396 |
309 |
$8K |
| 91322 |
|
238 |
238 |
$6K |
| 0064A |
|
83 |
82 |
$6K |
| G0008 |
Administration of influenza virus vaccine |
1,454 |
1,430 |
$4K |
| 90686 |
|
365 |
354 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
25 |
24 |
$2K |
| 0012A |
|
508 |
508 |
$2K |
| 0011A |
|
538 |
533 |
$2K |
| 90661 |
|
25 |
24 |
$944.88 |
| 0124A |
|
132 |
132 |
$572.40 |
| 0134A |
|
163 |
163 |
$457.92 |
| A4259 |
Lancets, per box of 100 |
919 |
862 |
$398.12 |
| 90694 |
|
207 |
207 |
$305.08 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
37 |
36 |
$237.60 |
| 0013A |
|
357 |
342 |
$0.00 |
| 90653 |
|
39 |
39 |
$0.00 |
| 91312 |
|
16 |
16 |
$0.00 |
| 91313 |
|
38 |
37 |
$0.00 |
| 91301 |
|
210 |
199 |
$0.00 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
113 |
113 |
$0.00 |
| 91306 |
|
53 |
53 |
$0.00 |
| 90480 |
|
197 |
197 |
$0.00 |