| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
9,663 |
9,457 |
$3.63M |
| A9276 |
Disposable sensor, cgm sys |
12,335 |
12,289 |
$2.80M |
| A9277 |
External transmitter, cgm |
3,486 |
3,485 |
$2.26M |
| T4535 |
Disposable liner/shield/pad |
12,349 |
12,310 |
$387K |
| A4554 |
Disposable underpads |
10,409 |
9,211 |
$317K |
| L2275 |
Plastic mod low ext pad/line |
3,984 |
2,245 |
$236K |
| L3020 |
Foot longitud/metatarsal sup |
2,293 |
1,259 |
$201K |
| T4523 |
Adult size brief/diaper lg |
2,940 |
2,905 |
$195K |
| A9278 |
External receiver, cgm sys |
752 |
752 |
$158K |
| T4539 |
Reuse diaper/brief any size |
5,919 |
5,898 |
$155K |
| T4524 |
Adult size brief/diaper xl |
1,875 |
1,869 |
$141K |
| E0575 |
Nebulizer ultrasonic |
361 |
346 |
$123K |
| T4522 |
Adult size brief/diaper med |
2,327 |
2,287 |
$118K |
| L3010 |
Foot longitudinal arch suppo |
1,287 |
745 |
$104K |
| E0570 |
Nebulizer with compression |
1,273 |
1,263 |
$90K |
| T4537 |
Reusable underpad bed size |
2,775 |
2,763 |
$84K |
| E0601 |
Cont airway pressure device |
765 |
758 |
$63K |
| E2103 |
Non-adju cgm receiver/mon |
169 |
165 |
$49K |
| A4230 |
Infus insulin pump non needl |
94 |
94 |
$43K |
| A5500 |
Diab shoe for density insert |
1,164 |
735 |
$38K |
| L3216 |
Orthoped ladies shoes dpth i |
685 |
468 |
$35K |
| S8101 |
Spacer with mask |
1,131 |
1,072 |
$30K |
| L3217 |
Ladies shoes hightop depth i |
571 |
317 |
$28K |
| A4927 |
Non-sterile gloves |
7,776 |
7,546 |
$27K |
| L3030 |
Foot arch support remov prem |
432 |
302 |
$26K |
| A5512 |
Multi den insert direct form |
990 |
640 |
$23K |
| L3221 |
Orthopedic mens shoes dpth i |
403 |
263 |
$22K |
| A7005 |
Nondisposable nebulizer set |
1,565 |
1,487 |
$19K |
| E0562 |
Humidifier heated used w pap |
665 |
659 |
$15K |
| L3222 |
Mens shoes hightop depth inl |
221 |
125 |
$12K |
| K0553 |
Ther cgm supply allowance |
281 |
281 |
$12K |
| A4232 |
Syringe w/needle insulin 3cc |
95 |
95 |
$10K |
| L3206 |
Hightop w/ supp/pronator chi |
406 |
204 |
$7K |
| L3215 |
Orthopedic ftwear ladies oxf |
102 |
57 |
$4K |
| L3219 |
Orthopedic mens shoes oxford |
81 |
49 |
$4K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
24 |
24 |
$4K |
| T4540 |
Reusable underpad chair size |
154 |
154 |
$3K |
| K0001 |
Standard wheelchair |
332 |
328 |
$3K |
| E0445 |
Oximeter non-invasive |
23 |
23 |
$2K |
| A7035 |
Pos airway press headgear |
198 |
196 |
$2K |
| A7037 |
Pos airway pressure tubing |
249 |
248 |
$2K |
| L3809 |
Whfo w/o joints pre ots |
23 |
12 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
67 |
67 |
$1K |
| A6530 |
Compression stocking bk18-30 |
12 |
12 |
$737.31 |
| K0195 |
Elevating whlchair leg rests |
295 |
294 |
$609.66 |
| A7038 |
Pos airway pressure filter |
259 |
258 |
$574.41 |
| E0143 |
Walker folding wheeled w/o s |
25 |
25 |
$441.91 |
| A7034 |
Nasal application device |
12 |
12 |
$384.67 |
| A7015 |
Aerosol mask used w nebulize |
210 |
210 |
$172.62 |
| E0156 |
Walker seat attachment |
25 |
25 |
$121.70 |
| A7039 |
Filter, non disposable w pap |
40 |
40 |
$77.21 |
| A4402 |
Lubricant per ounce |
12 |
12 |
$29.42 |
| A9274 |
Ext amb insulin delivery sys |
12 |
12 |
$0.00 |