| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
32,239 |
31,852 |
$1.93M |
| T4527 |
Adult size pull-on lg |
19,757 |
19,519 |
$1.93M |
| T4535 |
Disposable liner/shield/pad |
34,248 |
33,823 |
$1.60M |
| T4528 |
Adult size pull-on xl |
7,380 |
7,285 |
$964K |
| T4526 |
Adult size pull-on med |
4,147 |
4,087 |
$376K |
| A4927 |
Non-sterile gloves |
30,939 |
30,547 |
$373K |
| A6530 |
Compression stocking bk18-30 |
1,396 |
1,391 |
$92K |
| E0570 |
Nebulizer with compression |
754 |
730 |
$46K |
| A6539 |
Gc stocking waistlngth 18-30 |
338 |
336 |
$36K |
| T4543 |
Adult disp brief/diap abv xl |
112 |
112 |
$25K |
| L3040 |
Ft arch suprt premold longit |
310 |
307 |
$21K |
| A6533 |
Gc stocking thighlngth 18-30 |
180 |
180 |
$16K |
| A7005 |
Nondisposable nebulizer set |
642 |
637 |
$10K |
| A5512 |
Multi den insert direct form |
405 |
310 |
$10K |
| L3215 |
Orthopedic ftwear ladies oxf |
112 |
110 |
$10K |
| A5500 |
Diab shoe for density insert |
405 |
309 |
$9K |
| A4253 |
Blood glucose/reagent strips |
1,397 |
1,393 |
$6K |
| K0004 |
High strength ltwt whlchr |
300 |
292 |
$4K |
| L3219 |
Orthopedic mens shoes oxford |
42 |
41 |
$4K |
| A4670 |
Automatic bp monitor, dial |
26 |
26 |
$2K |
| E0240 |
Bath/shower chair |
15 |
15 |
$2K |
| L1810 |
Ko elastic with joints |
16 |
16 |
$544.00 |
| K0195 |
Elevating whlchair leg rests |
215 |
215 |
$412.42 |
| A4259 |
Lancets per box |
1,107 |
1,103 |
$377.43 |
| L1902 |
Afo ankle gauntlet pre ots |
13 |
13 |
$279.35 |