| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,075 |
4,041 |
$561K |
| A4554 |
Disposable underpads, all sizes |
3,857 |
3,827 |
$185K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,671 |
1,288 |
$158K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,599 |
1,586 |
$148K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
797 |
613 |
$79K |
| A4927 |
Gloves, non-sterile, per 100 |
3,739 |
3,710 |
$62K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
139 |
139 |
$15K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
501 |
280 |
$14K |