| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult disp brief/diap abv xl |
6,659 |
6,639 |
$1.16M |
| T4524 |
Adult size brief/diaper xl |
7,680 |
7,623 |
$1.08M |
| A4554 |
Disposable underpads |
16,681 |
16,455 |
$862K |
| L3410 |
Shoe metatarsal bar between |
19,421 |
9,970 |
$834K |
| L3217 |
Ladies shoes hightop depth i |
13,848 |
6,349 |
$689K |
| L3030 |
Foot arch support remov prem |
16,178 |
7,657 |
$671K |
| L3222 |
Mens shoes hightop depth inl |
6,177 |
2,919 |
$367K |
| L3001 |
Foot insert remov molded spe |
4,820 |
2,404 |
$346K |
| A6540 |
Gc stocking waistlngth 30-40 |
2,660 |
2,634 |
$345K |
| T4535 |
Disposable liner/shield/pad |
9,540 |
9,489 |
$332K |
| T4539 |
Reuse diaper/brief any size |
11,545 |
11,433 |
$329K |
| L3340 |
Shoe wedge sach |
10,496 |
5,370 |
$322K |
| L3485 |
Shoe heel pad removable for |
8,967 |
4,641 |
$210K |
| T4537 |
Reusable underpad bed size |
7,186 |
7,116 |
$178K |
| L1971 |
Afo w/ankle joint, prefab |
755 |
391 |
$144K |
| T4540 |
Reusable underpad chair size |
4,637 |
4,584 |
$59K |
| A4927 |
Non-sterile gloves |
11,998 |
11,591 |
$44K |
| T4523 |
Adult size brief/diaper lg |
405 |
404 |
$41K |
| L3206 |
Hightop w/ supp/pronator chi |
1,411 |
710 |
$32K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
125 |
124 |
$22K |
| A6539 |
Gc stocking waistlngth 18-30 |
311 |
305 |
$22K |
| L1820 |
Ko elas w/ condyle pads & jo |
382 |
223 |
$19K |
| A4670 |
Automatic bp monitor, dial |
446 |
443 |
$18K |
| A6530 |
Compression stocking bk18-30 |
875 |
441 |
$18K |
| A6533 |
Gc stocking thighlngth 18-30 |
619 |
309 |
$14K |
| L3390 |
Shoe outflare wedge |
573 |
300 |
$13K |
| A5500 |
Diab shoe for density insert |
874 |
437 |
$13K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
78 |
78 |
$12K |
| A5512 |
Multi den insert direct form |
791 |
397 |
$12K |
| L3310 |
Shoe lift elev heel/sole neo |
150 |
80 |
$7K |
| L1848 |
Ko dbl upright w/air pre ots |
24 |
14 |
$6K |
| L1906 |
Afo multilig ank sup pre ots |
76 |
43 |
$3K |
| L3400 |
Shoe metatarsal bar wedge ro |
167 |
87 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
135 |
135 |
$3K |
| L3808 |
Whfo, rigid w/o joints |
15 |
12 |
$3K |
| L1831 |
Knee orth pos locking joint |
23 |
12 |
$3K |
| T4522 |
Adult size brief/diaper med |
24 |
24 |
$2K |
| L3216 |
Orthoped ladies shoes dpth i |
64 |
31 |
$2K |
| E0240 |
Bath/shower chair |
45 |
45 |
$1K |
| E0570 |
Nebulizer with compression |
12 |
12 |
$928.80 |
| E0156 |
Walker seat attachment |
123 |
123 |
$804.60 |
| K0001 |
Standard wheelchair |
118 |
118 |
$570.21 |
| K0195 |
Elevating whlchair leg rests |
144 |
144 |
$139.94 |