| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,423 |
2,083 |
$282K |
| 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 |
892 |
718 |
$132K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
856 |
755 |
$96K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
798 |
741 |
$74K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
690 |
637 |
$71K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,255 |
1,111 |
$68K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
730 |
640 |
$63K |
| A4554 |
Disposable underpads, all sizes |
1,806 |
1,657 |
$49K |
| B4100 |
Food thickener, administered orally, per ounce |
544 |
430 |
$44K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
216 |
151 |
$23K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
257 |
226 |
$21K |
| 0001A |
|
578 |
538 |
$13K |
| 0002A |
|
516 |
480 |
$13K |
| A4927 |
Gloves, non-sterile, per 100 |
681 |
583 |
$12K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
268 |
209 |
$9K |
| A4259 |
Lancets, per box of 100 |
751 |
669 |
$8K |
| E0601 |
Continuous positive airway pressure (cpap) device |
159 |
129 |
$7K |
| B9998 |
Noc for enteral supplies |
211 |
155 |
$6K |
| 0072A |
|
67 |
66 |
$6K |
| 0071A |
|
67 |
65 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
54 |
48 |
$4K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
35 |
24 |
$3K |
| 0004A |
|
76 |
74 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
32 |
25 |
$1K |
| 0012A |
|
138 |
127 |
$1K |
| G0008 |
Administration of influenza virus vaccine |
298 |
294 |
$803.59 |
| 0011A |
|
148 |
137 |
$749.62 |
| 0064A |
|
62 |
60 |
$160.00 |
| 90756 |
|
70 |
70 |
$136.74 |
| 91300 |
|
924 |
800 |
$6.12 |
| 91307 |
|
134 |
128 |
$1.27 |
| 91301 |
|
87 |
84 |
$0.61 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
420 |
413 |
$0.00 |
| 90480 |
|
17 |
17 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
18 |
12 |
$0.00 |
| 0003A |
|
12 |
12 |
$0.00 |
| 90662 |
|
104 |
104 |
$0.00 |
| 91320 |
|
17 |
17 |
$0.00 |