| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
428 |
368 |
$81K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
983 |
918 |
$16K |
| A4215 |
Needle, sterile, any size, each |
324 |
286 |
$6K |
| 0001A |
|
142 |
141 |
$5K |
| 0002A |
|
75 |
75 |
$3K |
| 90674 |
|
66 |
61 |
$2K |
| 0031A |
|
40 |
40 |
$1K |
| 0011A |
|
43 |
42 |
$1K |
| 0071A |
|
29 |
27 |
$1K |
| 0072A |
|
21 |
21 |
$840.00 |
| 0012A |
|
20 |
20 |
$760.00 |
| 0051A |
|
13 |
13 |
$480.00 |
| 90480 |
|
17 |
13 |
$419.98 |
| 0124A |
|
18 |
18 |
$280.00 |
| 90694 |
|
14 |
12 |
$215.04 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
83 |
70 |
$142.52 |
| A4259 |
Lancets, per box of 100 |
13 |
12 |
$1.32 |
| 91301 |
|
36 |
36 |
$0.00 |
| 91303 |
|
15 |
15 |
$0.00 |
| 91300 |
|
146 |
124 |
$0.00 |