| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4245 |
Alcohol wipes, per box |
887 |
789 |
$3K |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
17 |
12 |
$864.68 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
155 |
81 |
$416.73 |
| 90686 |
|
105 |
105 |
$349.01 |
| 0003A |
|
120 |
117 |
$322.64 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
25 |
25 |
$321.18 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
39 |
39 |
$254.70 |
| 0124A |
|
117 |
117 |
$238.17 |
| 0034A |
|
25 |
22 |
$80.00 |
| 90662 |
|
56 |
56 |
$69.94 |
| 0012A |
|
14 |
14 |
$36.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
44 |
37 |
$18.43 |
| 0031A |
|
98 |
94 |
$14.15 |
| G0008 |
Administration of influenza virus vaccine |
299 |
297 |
$0.05 |
| 91312 |
|
33 |
33 |
$0.00 |
| 90688 |
|
124 |
122 |
$0.00 |
| 90656 |
|
26 |
26 |
$0.00 |
| 90674 |
|
19 |
19 |
$0.00 |