| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
46,072 |
24,593 |
$2.94M |
| L3216 |
Orthoped ladies shoes dpth i |
24,397 |
12,997 |
$1.07M |
| L3221 |
Orthopedic mens shoes dpth i |
18,531 |
9,796 |
$955K |
| L3020 |
Foot longitud/metatarsal sup |
3,660 |
1,890 |
$412K |
| L3217 |
Ladies shoes hightop depth i |
2,821 |
1,446 |
$213K |
| L3222 |
Mens shoes hightop depth inl |
2,313 |
1,173 |
$206K |
| L3215 |
Orthopedic ftwear ladies oxf |
2,532 |
1,341 |
$171K |
| L3219 |
Orthopedic mens shoes oxford |
1,819 |
951 |
$144K |
| A6530 |
Compression stocking bk18-30 |
3,987 |
2,090 |
$102K |
| T4523 |
Adult size brief/diaper lg |
621 |
616 |
$54K |
| T4522 |
Adult size brief/diaper med |
945 |
944 |
$52K |
| T4535 |
Disposable liner/shield/pad |
1,618 |
1,613 |
$48K |
| L3050 |
Foot arch supp premold metat |
1,164 |
570 |
$47K |
| A4554 |
Disposable underpads |
1,114 |
1,109 |
$34K |
| T4539 |
Reuse diaper/brief any size |
1,349 |
1,345 |
$33K |
| A5500 |
Diab shoe for density insert |
279 |
224 |
$20K |
| T4537 |
Reusable underpad bed size |
822 |
818 |
$15K |
| A5512 |
Multi den insert direct form |
266 |
208 |
$10K |
| L3070 |
Arch suprt att to sho longit |
28 |
16 |
$833.00 |