| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
961 |
884 |
$61K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
237 |
227 |
$49K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
394 |
342 |
$43K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
606 |
561 |
$31K |
| A4554 |
Disposable underpads, all sizes |
669 |
621 |
$29K |
| A4927 |
Gloves, non-sterile, per 100 |
1,455 |
1,147 |
$25K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
243 |
223 |
$25K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,391 |
903 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
93 |
91 |
$788.89 |
| A4245 |
Alcohol wipes, per box |
112 |
103 |
$350.00 |
| A4259 |
Lancets, per box of 100 |
93 |
91 |
$107.75 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
23 |
19 |
$0.00 |