| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
3,661 |
1,983 |
$209K |
| T4535 |
Disposable liner/shield/pad |
1,583 |
1,574 |
$63K |
| L3219 |
Orthopedic mens shoes oxford |
893 |
468 |
$62K |
| A6539 |
Gc stocking waistlngth 18-30 |
648 |
504 |
$56K |
| L3215 |
Orthopedic ftwear ladies oxf |
843 |
432 |
$48K |
| A6530 |
Compression stocking bk18-30 |
981 |
501 |
$27K |
| T4522 |
Adult size brief/diaper med |
374 |
372 |
$19K |
| L3216 |
Orthoped ladies shoes dpth i |
416 |
210 |
$17K |
| A4554 |
Disposable underpads |
337 |
332 |
$9K |
| T4523 |
Adult size brief/diaper lg |
87 |
87 |
$6K |
| L3221 |
Orthopedic mens shoes dpth i |
103 |
52 |
$5K |
| A4927 |
Non-sterile gloves |
138 |
137 |
$620.17 |
| T4539 |
Reuse diaper/brief any size |
12 |
12 |
$218.12 |