| Code | Description | Claims | Beneficiaries | Total Paid |
| T4523 |
Adult size brief/diaper lg |
31,252 |
31,187 |
$2.27M |
| A4554 |
Disposable underpads |
59,718 |
59,590 |
$2.24M |
| T4535 |
Disposable liner/shield/pad |
60,035 |
59,899 |
$1.86M |
| T4524 |
Adult size brief/diaper xl |
13,404 |
13,384 |
$1.01M |
| T4539 |
Reuse diaper/brief any size |
31,822 |
31,722 |
$868K |
| L3030 |
Foot arch support remov prem |
8,700 |
4,939 |
$528K |
| T4522 |
Adult size brief/diaper med |
8,815 |
8,795 |
$488K |
| T4537 |
Reusable underpad bed size |
14,053 |
14,001 |
$408K |
| T4543 |
Adult disp brief/diap abv xl |
2,502 |
2,502 |
$334K |
| L3216 |
Orthoped ladies shoes dpth i |
6,336 |
3,588 |
$258K |
| L3221 |
Orthopedic mens shoes dpth i |
3,278 |
1,835 |
$156K |
| A6539 |
Gc stocking waistlngth 18-30 |
1,473 |
1,472 |
$144K |
| T4540 |
Reusable underpad chair size |
5,714 |
5,688 |
$97K |
| A5500 |
Diab shoe for density insert |
3,325 |
2,208 |
$87K |
| A4927 |
Non-sterile gloves |
14,760 |
14,672 |
$76K |
| A5512 |
Multi den insert direct form |
3,271 |
2,182 |
$68K |
| A6530 |
Compression stocking bk18-30 |
2,220 |
1,309 |
$60K |
| E0240 |
Bath/shower chair |
311 |
311 |
$12K |
| L3215 |
Orthopedic ftwear ladies oxf |
125 |
78 |
$9K |
| E0156 |
Walker seat attachment |
327 |
326 |
$7K |
| A4670 |
Automatic bp monitor, dial |
169 |
167 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
236 |
236 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
298 |
297 |
$4K |
| K0001 |
Standard wheelchair |
995 |
982 |
$4K |
| L3002 |
Foot insert plastazote or eq |
33 |
17 |
$3K |
| A4335 |
Incontinence supply |
345 |
344 |
$2K |
| E1399 |
Durable medical equipment mi |
224 |
223 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
25 |
25 |
$942.90 |
| K0195 |
Elevating whlchair leg rests |
520 |
518 |
$730.32 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
12 |
12 |
$655.14 |
| E0260 |
Hosp bed semi-electr w/ matt |
41 |
41 |
$369.26 |
| E0241 |
Bath tub wall rail |
12 |
12 |
$321.32 |
| E0570 |
Nebulizer with compression |
12 |
12 |
$8.40 |