| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4532 |
Ped size pull-on lg |
2,423 |
2,083 |
$282K |
| B4150 |
Ef complet w/intact nutrient |
892 |
718 |
$132K |
| T4522 |
Adult size brief/diaper med |
856 |
755 |
$96K |
| T4527 |
Adult size pull-on lg |
798 |
741 |
$74K |
| T4523 |
Adult size brief/diaper lg |
690 |
637 |
$71K |
| A4253 |
Blood glucose/reagent strips |
1,255 |
1,111 |
$68K |
| T4531 |
Ped size pull-on sm/med |
730 |
640 |
$63K |
| A4554 |
Disposable underpads |
1,806 |
1,657 |
$49K |
| B4100 |
Food thickener oral |
544 |
430 |
$44K |
| T2028 |
Special supply, nos waiver |
216 |
151 |
$23K |
| T4526 |
Adult size pull-on med |
257 |
226 |
$21K |
| 0001A |
|
578 |
538 |
$13K |
| 0002A |
|
516 |
480 |
$13K |
| A4927 |
Non-sterile gloves |
681 |
583 |
$12K |
| 87426 |
|
268 |
209 |
$9K |
| A4259 |
Lancets per box |
751 |
669 |
$8K |
| E0601 |
Cont airway pressure device |
159 |
129 |
$7K |
| B9998 |
Enteral supp not otherwise c |
211 |
155 |
$6K |
| 0072A |
|
67 |
66 |
$6K |
| 0071A |
|
67 |
65 |
$6K |
| T4528 |
Adult size pull-on xl |
54 |
48 |
$4K |
| B4035 |
Enteral feed supp pump per d |
35 |
24 |
$3K |
| 0004A |
|
76 |
74 |
$2K |
| T4535 |
Disposable liner/shield/pad |
32 |
25 |
$1K |
| 0012A |
|
138 |
127 |
$1K |
| G0008 |
Admin influenza virus vac |
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 |
Covid test self-admn/collect |
420 |
413 |
$0.00 |
| 90480 |
|
17 |
17 |
$0.00 |
| A4520 |
Incontinence garment anytype |
18 |
12 |
$0.00 |
| 0003A |
|
12 |
12 |
$0.00 |
| 90662 |
|
104 |
104 |
$0.00 |
| 91320 |
|
17 |
17 |
$0.00 |