| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
27,777 |
26,214 |
$3.62M |
| T4535 |
Disposable liner/shield/pad |
31,511 |
29,601 |
$1.72M |
| A4554 |
Disposable underpads |
28,816 |
27,333 |
$1.58M |
| A6530 |
Compression stocking bk18-30 |
20,706 |
19,395 |
$1.45M |
| A6533 |
Gc stocking thighlngth 18-30 |
18,800 |
17,780 |
$1.40M |
| A4927 |
Non-sterile gloves |
29,082 |
28,069 |
$737K |
| A6250 |
Skin seal protect moisturizr |
21,776 |
21,369 |
$297K |
| A6539 |
Gc stocking waistlngth 18-30 |
2,513 |
2,469 |
$161K |
| T4528 |
Adult size pull-on xl |
1,143 |
1,061 |
$158K |
| B4150 |
Ef complet w/intact nutrient |
1,251 |
1,205 |
$117K |
| A4215 |
Sterile needle |
1,622 |
1,550 |
$71K |
| L3216 |
Orthoped ladies shoes dpth i |
257 |
212 |
$46K |
| L3060 |
Foot arch supp longitud/meta |
1,252 |
903 |
$37K |
| T4526 |
Adult size pull-on med |
273 |
270 |
$35K |
| E0190 |
Positioning cushion |
145 |
132 |
$34K |
| A4245 |
Alcohol wipes per box |
3,378 |
3,234 |
$29K |
| A4253 |
Blood glucose/reagent strips |
2,466 |
2,353 |
$28K |
| A5131 |
Appliance cleaner |
3,009 |
2,781 |
$24K |
| T4523 |
Adult size brief/diaper lg |
332 |
256 |
$23K |
| T4544 |
Adlt disp und/pull on abv xl |
74 |
71 |
$15K |
| A4259 |
Lancets per box |
2,361 |
2,266 |
$6K |
| A4670 |
Automatic bp monitor, dial |
85 |
77 |
$5K |
| E0607 |
Blood glucose monitor home |
88 |
88 |
$3K |
| S8490 |
100 insulin syringes |
81 |
77 |
$3K |
| A5500 |
Diab shoe for density insert |
36 |
18 |
$2K |
| A5512 |
Multi den insert direct form |
79 |
47 |
$1K |
| K0001 |
Standard wheelchair |
104 |
99 |
$1K |
| A4258 |
Lancet device each |
90 |
89 |
$337.55 |