| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
28,281 |
28,021 |
$1.22M |
| T4527 |
Adult size pull-on lg |
10,105 |
10,032 |
$812K |
| T4528 |
Adult size pull-on xl |
4,625 |
4,601 |
$495K |
| T4526 |
Adult size pull-on med |
3,256 |
3,228 |
$220K |
| T4541 |
Large disposable underpad |
5,778 |
5,722 |
$214K |
| L3216 |
Orthoped ladies shoes dpth i |
1,007 |
999 |
$70K |
| A5512 |
Multi den insert direct form |
1,772 |
1,353 |
$28K |
| A5500 |
Diab shoe for density insert |
1,907 |
1,355 |
$25K |
| L3030 |
Foot arch support remov prem |
1,521 |
1,500 |
$9K |
| L3221 |
Orthopedic mens shoes dpth i |
133 |
132 |
$9K |
| T4525 |
Adult size pull-on sm |
101 |
96 |
$9K |
| T4537 |
Reusable underpad bed size |
37 |
37 |
$605.72 |