| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
37,418 |
37,294 |
$1.08M |
| A4554 |
Disposable underpads |
27,627 |
27,527 |
$705K |
| T4523 |
Adult size brief/diaper lg |
8,881 |
8,836 |
$500K |
| T4524 |
Adult size brief/diaper xl |
5,216 |
5,192 |
$322K |
| L3030 |
Foot arch support remov prem |
3,408 |
2,774 |
$301K |
| T4522 |
Adult size brief/diaper med |
6,287 |
6,257 |
$291K |
| T4539 |
Reuse diaper/brief any size |
6,383 |
6,353 |
$159K |
| L3216 |
Orthoped ladies shoes dpth i |
2,528 |
2,050 |
$150K |
| T4537 |
Reusable underpad bed size |
4,406 |
4,388 |
$125K |
| T4543 |
Adult disp brief/diap abv xl |
832 |
822 |
$96K |
| B4150 |
Ef complet w/intact nutrient |
563 |
560 |
$53K |
| A4927 |
Non-sterile gloves |
10,709 |
10,640 |
$51K |
| A4670 |
Automatic bp monitor, dial |
1,112 |
1,104 |
$48K |
| L3221 |
Orthopedic mens shoes dpth i |
645 |
528 |
$45K |
| B4154 |
Ef spec metabolic noninherit |
150 |
147 |
$19K |
| A4402 |
Lubricant per ounce |
847 |
844 |
$4K |
| E0240 |
Bath/shower chair |
135 |
135 |
$4K |
| A6530 |
Compression stocking bk18-30 |
146 |
120 |
$4K |
| L3217 |
Ladies shoes hightop depth i |
25 |
25 |
$3K |
| E0241 |
Bath tub wall rail |
96 |
96 |
$3K |
| A4253 |
Blood glucose/reagent strips |
359 |
351 |
$3K |
| T4521 |
Adult size brief/diaper sm |
61 |
61 |
$3K |
| A4335 |
Incontinence supply |
292 |
291 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
12 |
12 |
$432.00 |
| A4259 |
Lancets per box |
83 |
82 |
$150.94 |