| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
9,764 |
9,513 |
$2.07M |
| A6250 |
Skin seal protect moisturizr |
12,510 |
11,351 |
$966K |
| A4554 |
Disposable underpads |
10,990 |
10,704 |
$662K |
| T4535 |
Disposable liner/shield/pad |
8,721 |
8,417 |
$354K |
| A4927 |
Non-sterile gloves |
12,690 |
11,507 |
$348K |
| A6530 |
Compression stocking bk18-30 |
7,625 |
7,430 |
$289K |
| T4544 |
Adlt disp und/pull on abv xl |
505 |
502 |
$193K |
| A6533 |
Gc stocking thighlngth 18-30 |
1,832 |
1,787 |
$72K |
| A4252 |
Blood ketone test or strip |
140 |
133 |
$59K |
| T4528 |
Adult size pull-on xl |
261 |
258 |
$38K |
| L3216 |
Orthoped ladies shoes dpth i |
265 |
163 |
$32K |
| A6531 |
Compress stking bk30-40 surg |
3,541 |
1,832 |
$31K |
| T4526 |
Adult size pull-on med |
328 |
300 |
$30K |
| L3030 |
Foot arch support remov prem |
382 |
181 |
$7K |
| A4253 |
Blood glucose/reagent strips |
777 |
743 |
$6K |
| L3221 |
Orthopedic mens shoes dpth i |
28 |
24 |
$5K |
| A4245 |
Alcohol wipes per box |
896 |
825 |
$4K |
| A4259 |
Lancets per box |
778 |
754 |
$794.50 |