| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
2,887 |
2,857 |
$106K |
| A4554 |
Disposable underpads |
2,128 |
2,092 |
$94K |
| T4523 |
Adult size brief/diaper lg |
769 |
763 |
$57K |
| T4539 |
Reuse diaper/brief any size |
1,076 |
1,060 |
$31K |
| L3030 |
Foot arch support remov prem |
423 |
250 |
$29K |
| T4522 |
Adult size brief/diaper med |
216 |
211 |
$14K |
| T4537 |
Reusable underpad bed size |
197 |
193 |
$6K |
| A4927 |
Non-sterile gloves |
1,093 |
1,084 |
$5K |
| K0553 |
Ther cgm supply allowance |
25 |
25 |
$4K |
| L3221 |
Orthopedic mens shoes dpth i |
47 |
27 |
$2K |
| A4239 |
Non-adju cgm supply allow |
54 |
54 |
$2K |
| T4524 |
Adult size brief/diaper xl |
25 |
25 |
$2K |
| L3216 |
Orthoped ladies shoes dpth i |
22 |
14 |
$1K |
| E0570 |
Nebulizer with compression |
79 |
79 |
$395.62 |
| A4253 |
Blood glucose/reagent strips |
50 |
49 |
$255.23 |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$170.30 |
| A4259 |
Lancets per box |
12 |
12 |
$16.74 |