| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
437 |
437 |
$18K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
303 |
288 |
$12K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
42 |
42 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
521 |
521 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
25 |
25 |
$78.23 |
| A4259 |
Lancets, per box of 100 |
24 |
24 |
$7.88 |
| G0008 |
Administration of influenza virus vaccine |
381 |
381 |
$0.00 |
| 90732 |
|
12 |
12 |
$0.00 |
| 90688 |
|
115 |
115 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
12 |
12 |
$0.00 |
| 90756 |
|
266 |
266 |
$0.00 |