| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult size brief/diaper xl |
7,492 |
7,363 |
$1.08M |
| L1832 |
Ko adj jnt pos r sup pre cst |
1,877 |
1,172 |
$371K |
| L0631 |
Lso sag r an/pos pnl pre cst |
1,223 |
1,161 |
$336K |
| A4554 |
Disposable underpads |
7,163 |
7,042 |
$335K |
| L3030 |
Foot arch support remov prem |
3,116 |
1,375 |
$170K |
| A4927 |
Non-sterile gloves |
6,995 |
6,872 |
$119K |
| A6531 |
Compress stking bk30-40 surg |
2,375 |
1,099 |
$103K |
| L3216 |
Orthoped ladies shoes dpth i |
2,404 |
1,075 |
$88K |
| L1971 |
Afo w/ankle joint, prefab |
438 |
250 |
$66K |
| L3808 |
Whfo, rigid w/o joints |
581 |
397 |
$64K |
| L3222 |
Mens shoes hightop depth inl |
1,161 |
551 |
$54K |
| E0570 |
Nebulizer with compression |
682 |
586 |
$43K |
| E0147 |
Walker variable wheel resist |
404 |
357 |
$39K |
| L3040 |
Ft arch suprt premold longit |
844 |
364 |
$34K |
| L0180 |
Cer post col occ/man sup adj |
178 |
169 |
$25K |
| A4670 |
Automatic bp monitor, dial |
992 |
932 |
$21K |
| L2397 |
Suspension sleeve lower ext |
450 |
346 |
$19K |
| K0195 |
Elevating whlchair leg rests |
575 |
510 |
$9K |
| E0245 |
Tub stool or bench |
81 |
80 |
$7K |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$5K |
| E0973 |
W/ch access det adj armrest |
77 |
46 |
$5K |
| K0001 |
Standard wheelchair |
187 |
148 |
$3K |
| L3221 |
Orthopedic mens shoes dpth i |
59 |
30 |
$3K |
| E2612 |
Gen use back cush wdth>=22in |
16 |
16 |
$3K |
| E0730 |
Tens four lead |
67 |
60 |
$3K |
| E2602 |
Gen w/c cushion wdth >=22 in |
29 |
28 |
$1K |
| A6530 |
Compression stocking bk18-30 |
28 |
15 |
$1K |
| L3675 |
So vest canvas/web pre ots |
19 |
16 |
$1K |
| A7010 |
Disposable corrugated tubing |
294 |
215 |
$953.90 |
| E0105 |
Cane adjust/fixed quad/3 pro |
13 |
12 |
$298.86 |
| E0961 |
Wheelchair brake extension |
16 |
16 |
$273.09 |
| K0002 |
Stnd hemi (low seat) whlchr |
26 |
24 |
$181.07 |
| A7015 |
Aerosol mask used w nebulize |
296 |
216 |
$147.11 |