| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
17 |
16 |
$275.77 |
| 90662 |
|
668 |
637 |
$0.00 |
| 91322 |
|
142 |
142 |
$0.00 |
| 0013A |
|
286 |
286 |
$0.00 |
| 90670 |
|
15 |
15 |
$0.00 |
| 0003A |
|
53 |
53 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
1,210 |
1,175 |
$0.00 |
| 0134A |
|
136 |
136 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
23 |
21 |
$0.00 |
| 0064A |
|
192 |
192 |
$0.00 |
| 90686 |
|
165 |
161 |
$0.00 |
| 0011A |
|
403 |
403 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
34 |
34 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
13 |
13 |
$0.00 |
| 0012A |
|
382 |
382 |
$0.00 |
| 90674 |
|
220 |
220 |
$0.00 |
| 90656 |
|
16 |
16 |
$0.00 |
| 90480 |
|
143 |
143 |
$0.00 |
| 90688 |
|
106 |
106 |
$0.00 |
| 0031A |
|
89 |
89 |
$0.00 |
| 90677 |
|
17 |
17 |
$0.00 |