| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult size brief/diaper xl |
6,774 |
6,709 |
$903K |
| A4554 |
Disposable underpads |
10,591 |
10,494 |
$608K |
| L3030 |
Foot arch support remov prem |
9,992 |
4,266 |
$406K |
| L3217 |
Ladies shoes hightop depth i |
5,929 |
2,425 |
$285K |
| T4535 |
Disposable liner/shield/pad |
6,851 |
6,815 |
$256K |
| T4539 |
Reuse diaper/brief any size |
7,602 |
7,548 |
$238K |
| L3410 |
Shoe metatarsal bar between |
4,641 |
2,679 |
$222K |
| L3222 |
Mens shoes hightop depth inl |
2,978 |
1,272 |
$169K |
| T4543 |
Adult disp brief/diap abv xl |
757 |
755 |
$145K |
| T4537 |
Reusable underpad bed size |
4,923 |
4,884 |
$134K |
| T4523 |
Adult size brief/diaper lg |
1,037 |
1,031 |
$94K |
| L3485 |
Shoe heel pad removable for |
2,687 |
1,726 |
$78K |
| A6540 |
Gc stocking waistlngth 30-40 |
416 |
393 |
$61K |
| L3340 |
Shoe wedge sach |
1,755 |
852 |
$50K |
| T4540 |
Reusable underpad chair size |
3,279 |
3,248 |
$46K |
| T4522 |
Adult size brief/diaper med |
537 |
533 |
$37K |
| A4927 |
Non-sterile gloves |
7,881 |
7,806 |
$34K |
| L1820 |
Ko elas w/ condyle pads & jo |
714 |
401 |
$27K |
| L3206 |
Hightop w/ supp/pronator chi |
699 |
349 |
$16K |
| L3002 |
Foot insert plastazote or eq |
176 |
88 |
$15K |
| L3216 |
Orthoped ladies shoes dpth i |
583 |
199 |
$15K |
| A4670 |
Automatic bp monitor, dial |
314 |
312 |
$15K |
| A5500 |
Diab shoe for density insert |
573 |
286 |
$12K |
| A6530 |
Compression stocking bk18-30 |
763 |
322 |
$12K |
| A4239 |
Non-adju cgm supply allow |
203 |
198 |
$10K |
| A6539 |
Gc stocking waistlngth 18-30 |
136 |
98 |
$8K |
| A5512 |
Multi den insert direct form |
543 |
271 |
$8K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
36 |
36 |
$7K |
| L3221 |
Orthopedic mens shoes dpth i |
170 |
65 |
$5K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
72 |
72 |
$5K |
| L3001 |
Foot insert remov molded spe |
26 |
13 |
$2K |
| E0240 |
Bath/shower chair |
39 |
39 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
43 |
43 |
$1K |
| K0001 |
Standard wheelchair |
105 |
104 |
$1K |
| T4521 |
Adult size brief/diaper sm |
13 |
13 |
$773.30 |
| S8101 |
Spacer with mask |
13 |
12 |
$666.00 |
| E0156 |
Walker seat attachment |
43 |
43 |
$349.65 |
| A7005 |
Nondisposable nebulizer set |
13 |
12 |
$194.28 |
| K0195 |
Elevating whlchair leg rests |
168 |
168 |
$187.27 |