| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
2,248 |
2,196 |
$361K |
| A5512 |
Multi den insert direct form |
554 |
398 |
$50K |
| A5500 |
Diab shoe for density insert |
742 |
521 |
$50K |
| E2103 |
Non-adju cgm receiver/mon |
278 |
278 |
$40K |
| A4253 |
Blood glucose/reagent strips |
296 |
286 |
$12K |
| A9276 |
Disposable sensor, cgm sys |
30 |
29 |
$10K |
| A4230 |
Infus insulin pump non needl |
98 |
85 |
$8K |
| A4232 |
Syringe w/needle insulin 3cc |
100 |
95 |
$2K |
| A4259 |
Lancets per box |
117 |
117 |
$651.48 |
| E0607 |
Blood glucose monitor home |
12 |
12 |
$560.61 |