| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
2,229 |
1,400 |
$107K |
| L1906 |
Afo multilig ank sup pre ots |
1,976 |
1,580 |
$72K |
| T4535 |
Disposable liner/shield/pad |
2,231 |
2,228 |
$61K |
| L3002 |
Foot insert plastazote or eq |
838 |
649 |
$46K |
| T4523 |
Adult size brief/diaper lg |
549 |
548 |
$43K |
| T4539 |
Reuse diaper/brief any size |
1,541 |
1,541 |
$43K |
| T4522 |
Adult size brief/diaper med |
637 |
637 |
$30K |
| A4554 |
Disposable underpads |
801 |
799 |
$27K |
| L3050 |
Foot arch supp premold metat |
1,466 |
852 |
$26K |
| T4537 |
Reusable underpad bed size |
545 |
545 |
$19K |
| L3216 |
Orthoped ladies shoes dpth i |
298 |
204 |
$14K |
| L4396 |
Static or dynami afo pre cst |
183 |
150 |
$13K |
| L3221 |
Orthopedic mens shoes dpth i |
111 |
68 |
$6K |
| L3224 |
Woman's shoe oxford brace |
181 |
99 |
$3K |
| A4927 |
Non-sterile gloves |
742 |
742 |
$3K |
| A6530 |
Compression stocking bk18-30 |
66 |
33 |
$959.82 |
| L3225 |
Man's shoe oxford brace |
49 |
26 |
$820.97 |