| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,911 |
1,244 |
$79K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,958 |
1,196 |
$69K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,031 |
753 |
$55K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
96 |
54 |
$4K |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
202 |
100 |
$3K |
| 0003A |
|
751 |
503 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
414 |
309 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
28 |
28 |
$2K |
| 90686 |
|
519 |
515 |
$2K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
95 |
95 |
$1K |
| 0031A |
|
410 |
340 |
$849.00 |
| 0124A |
|
242 |
242 |
$798.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
78 |
75 |
$679.00 |
| G0333 |
Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
20 |
20 |
$296.40 |
| 0034A |
|
83 |
51 |
$295.54 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
50 |
40 |
$289.30 |
| 0013A |
|
53 |
49 |
$247.11 |
| 0134A |
|
60 |
60 |
$168.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
47 |
25 |
$127.65 |
| 0012A |
|
34 |
31 |
$122.40 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
29 |
13 |
$68.25 |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
656 |
521 |
$60.32 |
| 90656 |
|
129 |
128 |
$59.31 |
| 0002A |
|
33 |
19 |
$42.59 |
| 90662 |
|
95 |
95 |
$1.40 |
| 91312 |
|
76 |
76 |
$0.00 |
| 90756 |
|
82 |
79 |
$0.00 |
| 91304 |
|
96 |
95 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
950 |
745 |
$0.00 |
| 90480 |
|
92 |
92 |
$0.00 |