| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
20,292 |
20,249 |
$505K |
| T4523 |
Adult size brief/diaper lg |
7,391 |
7,368 |
$459K |
| A4554 |
Disposable underpads |
17,531 |
17,489 |
$389K |
| L3030 |
Foot arch support remov prem |
3,033 |
2,231 |
$249K |
| T4524 |
Adult size brief/diaper xl |
3,637 |
3,629 |
$210K |
| T4522 |
Adult size brief/diaper med |
3,081 |
3,075 |
$136K |
| T4539 |
Reuse diaper/brief any size |
4,564 |
4,533 |
$128K |
| L3217 |
Ladies shoes hightop depth i |
733 |
399 |
$60K |
| T4537 |
Reusable underpad bed size |
1,695 |
1,686 |
$53K |
| T4543 |
Adult disp brief/diap abv xl |
397 |
395 |
$43K |
| L3216 |
Orthoped ladies shoes dpth i |
655 |
637 |
$43K |
| A4253 |
Blood glucose/reagent strips |
2,165 |
2,148 |
$26K |
| A4215 |
Sterile needle |
555 |
555 |
$20K |
| A5500 |
Diab shoe for density insert |
385 |
312 |
$16K |
| L3221 |
Orthopedic mens shoes dpth i |
195 |
177 |
$15K |
| A5512 |
Multi den insert direct form |
295 |
248 |
$9K |
| A4259 |
Lancets per box |
1,798 |
1,787 |
$6K |
| A4927 |
Non-sterile gloves |
1,318 |
1,297 |
$5K |
| T4521 |
Adult size brief/diaper sm |
126 |
126 |
$5K |
| E1399 |
Durable medical equipment mi |
94 |
94 |
$2K |
| A4245 |
Alcohol wipes per box |
1,196 |
1,196 |
$1K |
| S8490 |
100 insulin syringes |
93 |
93 |
$1K |
| A4402 |
Lubricant per ounce |
152 |
152 |
$727.84 |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$570.80 |