| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1971 |
Afo w/ankle joint, prefab |
350 |
199 |
$71K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
132 |
132 |
$63K |
| A4554 |
Disposable underpads |
383 |
381 |
$13K |
| L3010 |
Foot longitudinal arch suppo |
109 |
69 |
$11K |
| T4523 |
Adult size brief/diaper lg |
123 |
121 |
$10K |
| T4535 |
Disposable liner/shield/pad |
307 |
307 |
$8K |
| L2820 |
Soft interface below knee se |
119 |
79 |
$8K |
| L3030 |
Foot arch support remov prem |
59 |
31 |
$4K |
| L2275 |
Plastic mod low ext pad/line |
16 |
15 |
$2K |
| A5500 |
Diab shoe for density insert |
61 |
32 |
$2K |
| T4537 |
Reusable underpad bed size |
42 |
40 |
$2K |
| A5513 |
Multi den insert custom mold |
36 |
18 |
$2K |
| L3221 |
Orthopedic mens shoes dpth i |
27 |
17 |
$1K |
| L3410 |
Shoe metatarsal bar between |
21 |
17 |
$1K |
| T4539 |
Reuse diaper/brief any size |
41 |
40 |
$1K |
| L3216 |
Orthoped ladies shoes dpth i |
32 |
16 |
$1K |
| L2210 |
Dorsiflexion assist each joi |
16 |
12 |
$399.14 |
| A4927 |
Non-sterile gloves |
72 |
71 |
$316.00 |
| A4239 |
Non-adju cgm supply allow |
19 |
19 |
$0.00 |
| E2103 |
Non-adju cgm receiver/mon |
18 |
18 |
$0.00 |