| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item nos each |
34,499 |
33,300 |
$2.09M |
| T4526 |
Adult size pull-on med |
8,327 |
8,098 |
$960K |
| T4523 |
Adult size brief/diaper lg |
8,174 |
7,888 |
$943K |
| T4527 |
Adult size pull-on lg |
7,790 |
7,582 |
$938K |
| A4554 |
Disposable underpads |
20,039 |
19,450 |
$852K |
| T4522 |
Adult size brief/diaper med |
6,817 |
6,629 |
$679K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,011 |
2,793 |
$647K |
| B4150 |
Ef complet w/intact nutrient |
2,989 |
2,757 |
$557K |
| A4927 |
Non-sterile gloves |
35,840 |
34,602 |
$506K |
| T4528 |
Adult size pull-on xl |
4,362 |
4,249 |
$484K |
| T4524 |
Adult size brief/diaper xl |
2,733 |
2,616 |
$347K |
| T4534 |
Youth size pull-on |
2,101 |
2,048 |
$237K |
| A9900 |
Supply/accessory/service |
4,722 |
3,822 |
$183K |
| T4525 |
Adult size pull-on sm |
1,647 |
1,592 |
$177K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
490 |
485 |
$90K |
| A4253 |
Blood glucose/reagent strips |
3,933 |
3,327 |
$86K |
| T4535 |
Disposable liner/shield/pad |
1,286 |
1,239 |
$43K |
| J7626 |
Budesonide non-comp unit |
441 |
262 |
$10K |
| A4259 |
Lancets per box |
1,973 |
1,720 |
$9K |
| T4544 |
Adlt disp und/pull on abv xl |
16 |
12 |
$3K |
| B4034 |
Enter feed supkit syr by day |
483 |
25 |
$2K |
| A4215 |
Sterile needle |
360 |
312 |
$1K |
| J7613 |
Albuterol non-comp unit |
1,025 |
657 |
$1K |
| B4155 |
Ef incomplete/modular |
18 |
15 |
$980.50 |
| E0607 |
Blood glucose monitor home |
15 |
15 |
$365.68 |
| 91320 |
|
240 |
212 |
$0.00 |
| 0004A |
|
245 |
224 |
$0.00 |
| 90670 |
|
25 |
23 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
1,149 |
1,081 |
$0.00 |
| G0008 |
Admin influenza virus vac |
1,605 |
1,443 |
$0.00 |
| 90686 |
|
1,039 |
929 |
$0.00 |
| 0134A |
|
75 |
66 |
$0.00 |
| 0064A |
|
68 |
52 |
$0.00 |
| 90480 |
|
262 |
207 |
$0.00 |
| 90674 |
|
262 |
237 |
$0.00 |
| 90656 |
|
262 |
232 |
$0.00 |
| 90688 |
|
30 |
29 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
26 |
23 |
$0.00 |