| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
3,314 |
1,669 |
$146K |
| L3216 |
Orthoped ladies shoes dpth i |
1,695 |
853 |
$44K |
| L3221 |
Orthopedic mens shoes dpth i |
1,326 |
666 |
$40K |
| L1820 |
Ko elas w/ condyle pads & jo |
515 |
260 |
$16K |
| T4535 |
Disposable liner/shield/pad |
521 |
520 |
$16K |
| T4523 |
Adult size brief/diaper lg |
146 |
143 |
$12K |
| A4554 |
Disposable underpads |
253 |
250 |
$10K |
| T4522 |
Adult size brief/diaper med |
189 |
189 |
$10K |
| L1971 |
Afo w/ankle joint, prefab |
124 |
66 |
$8K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
84 |
84 |
$6K |
| T4539 |
Reuse diaper/brief any size |
176 |
176 |
$5K |
| A5512 |
Multi den insert direct form |
197 |
97 |
$5K |
| L3807 |
Whfo w/o joints pre cst |
123 |
63 |
$5K |
| A5500 |
Diab shoe for density insert |
200 |
98 |
$5K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
29 |
29 |
$2K |
| L3040 |
Ft arch suprt premold longit |
98 |
49 |
$1K |
| A4927 |
Non-sterile gloves |
79 |
78 |
$359.24 |