| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
1,047 |
1,014 |
$474K |
| E0570 |
Nebulizer with compression |
1,597 |
1,588 |
$168K |
| A4554 |
Disposable underpads |
1,070 |
1,067 |
$81K |
| T4537 |
Reusable underpad bed size |
713 |
712 |
$24K |
| L3215 |
Orthopedic ftwear ladies oxf |
124 |
119 |
$15K |
| T4540 |
Reusable underpad chair size |
575 |
572 |
$10K |
| L3219 |
Orthopedic mens shoes oxford |
38 |
37 |
$6K |
| A4927 |
Non-sterile gloves |
1,248 |
1,243 |
$5K |
| L3480 |
Shoe heel pad & depress for |
51 |
50 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,456 |
1,445 |
$1K |
| T4522 |
Adult size brief/diaper med |
12 |
12 |
$1K |
| A7005 |
Nondisposable nebulizer set |
68 |
68 |
$991.44 |