| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult size brief/diaper xl |
20,676 |
20,230 |
$2.30M |
| A4554 |
Disposable underpads |
50,786 |
50,091 |
$2.26M |
| L3030 |
Foot arch support remov prem |
34,508 |
18,263 |
$2.15M |
| T4543 |
Adult disp brief/diap abv xl |
8,505 |
8,496 |
$1.86M |
| T4535 |
Disposable liner/shield/pad |
38,931 |
38,481 |
$1.16M |
| L3216 |
Orthoped ladies shoes dpth i |
20,805 |
10,902 |
$946K |
| T4539 |
Reuse diaper/brief any size |
35,195 |
34,576 |
$920K |
| T4523 |
Adult size brief/diaper lg |
11,744 |
11,662 |
$820K |
| L3001 |
Foot insert remov molded spe |
7,380 |
4,043 |
$689K |
| L3217 |
Ladies shoes hightop depth i |
8,546 |
4,851 |
$570K |
| T4537 |
Reusable underpad bed size |
22,144 |
21,805 |
$570K |
| L3221 |
Orthopedic mens shoes dpth i |
10,544 |
5,489 |
$552K |
| L3222 |
Mens shoes hightop depth inl |
3,461 |
1,952 |
$257K |
| A6530 |
Compression stocking bk18-30 |
7,071 |
3,440 |
$251K |
| T4522 |
Adult size brief/diaper med |
4,980 |
4,964 |
$245K |
| T4540 |
Reusable underpad chair size |
12,746 |
12,490 |
$177K |
| L3410 |
Shoe metatarsal bar between |
2,448 |
1,234 |
$156K |
| A6540 |
Gc stocking waistlngth 30-40 |
793 |
773 |
$131K |
| A4927 |
Non-sterile gloves |
28,445 |
27,968 |
$126K |
| L3485 |
Shoe heel pad removable for |
1,701 |
933 |
$61K |
| L3340 |
Shoe wedge sach |
833 |
413 |
$38K |
| A4670 |
Automatic bp monitor, dial |
786 |
770 |
$31K |
| T4521 |
Adult size brief/diaper sm |
504 |
504 |
$22K |
| L3010 |
Foot longitudinal arch suppo |
186 |
88 |
$20K |
| A6533 |
Gc stocking thighlngth 18-30 |
491 |
259 |
$19K |
| A4335 |
Incontinence supply |
6,379 |
6,354 |
$14K |
| L3060 |
Foot arch supp longitud/meta |
233 |
119 |
$11K |
| A6539 |
Gc stocking waistlngth 18-30 |
75 |
74 |
$7K |
| E0240 |
Bath/shower chair |
194 |
192 |
$7K |
| A4402 |
Lubricant per ounce |
2,173 |
2,168 |
$7K |
| L3050 |
Foot arch supp premold metat |
145 |
69 |
$6K |
| L3002 |
Foot insert plastazote or eq |
23 |
13 |
$3K |
| A4660 |
Sphyg/bp app w cuff and stet |
66 |
66 |
$1K |
| E0241 |
Bath tub wall rail |
28 |
28 |
$858.01 |