| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
55,539 |
55,345 |
$2.42M |
| T4524 |
Adult size brief/diaper xl |
19,931 |
19,861 |
$2.04M |
| T4543 |
Adult disp brief/diap abv xl |
8,514 |
8,493 |
$1.95M |
| T4535 |
Disposable liner/shield/pad |
52,814 |
52,652 |
$1.93M |
| T4539 |
Reuse diaper/brief any size |
45,257 |
45,129 |
$1.33M |
| T4523 |
Adult size brief/diaper lg |
14,590 |
14,547 |
$1.10M |
| L3030 |
Foot arch support remov prem |
13,686 |
7,118 |
$864K |
| T4537 |
Reusable underpad bed size |
24,477 |
24,419 |
$837K |
| L3217 |
Ladies shoes hightop depth i |
9,090 |
4,814 |
$755K |
| T4522 |
Adult size brief/diaper med |
7,159 |
7,143 |
$376K |
| L3222 |
Mens shoes hightop depth inl |
3,412 |
1,803 |
$331K |
| A4927 |
Non-sterile gloves |
56,310 |
56,143 |
$257K |
| L3001 |
Foot insert remov molded spe |
1,823 |
1,116 |
$246K |
| T4540 |
Reusable underpad chair size |
13,551 |
13,517 |
$242K |
| L3216 |
Orthoped ladies shoes dpth i |
2,913 |
1,587 |
$118K |
| E0445 |
Oximeter non-invasive |
67 |
67 |
$111K |
| A6540 |
Gc stocking waistlngth 30-40 |
525 |
498 |
$89K |
| L3410 |
Shoe metatarsal bar between |
1,125 |
671 |
$86K |
| A4670 |
Automatic bp monitor, dial |
962 |
959 |
$47K |
| T4521 |
Adult size brief/diaper sm |
865 |
864 |
$37K |
| L3221 |
Orthopedic mens shoes dpth i |
618 |
354 |
$28K |
| L3485 |
Shoe heel pad removable for |
545 |
371 |
$26K |
| L3340 |
Shoe wedge sach |
518 |
272 |
$25K |
| A5500 |
Diab shoe for density insert |
1,082 |
574 |
$19K |
| L3000 |
Ft insert ucb berkeley shell |
33 |
33 |
$17K |
| L3002 |
Foot insert plastazote or eq |
85 |
71 |
$16K |
| A6530 |
Compression stocking bk18-30 |
782 |
400 |
$16K |
| A5512 |
Multi den insert direct form |
988 |
524 |
$13K |
| L3390 |
Shoe outflare wedge |
184 |
141 |
$10K |
| L3060 |
Foot arch supp longitud/meta |
52 |
49 |
$4K |
| A6539 |
Gc stocking waistlngth 18-30 |
37 |
37 |
$4K |
| A6533 |
Gc stocking thighlngth 18-30 |
53 |
29 |
$1K |
| E0240 |
Bath/shower chair |
31 |
31 |
$1K |
| K0001 |
Standard wheelchair |
238 |
238 |
$998.68 |
| A4335 |
Incontinence supply |
150 |
150 |
$912.20 |
| K0195 |
Elevating whlchair leg rests |
252 |
252 |
$308.40 |
| A4660 |
Sphyg/bp app w cuff and stet |
12 |
12 |
$246.08 |
| L0627 |
Lo sag ri an/pos pnl pre cst |
39 |
39 |
$238.80 |
| L1820 |
Ko elas w/ condyle pads & jo |
68 |
36 |
$0.00 |