| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
7,343 |
7,170 |
$909K |
| L3002 |
Foot insert plastazote or eq |
11,309 |
4,547 |
$530K |
| A4554 |
Disposable underpads |
12,611 |
12,260 |
$489K |
| T4528 |
Adult size pull-on xl |
2,610 |
2,556 |
$301K |
| T4526 |
Adult size pull-on med |
3,133 |
3,071 |
$301K |
| L3216 |
Orthoped ladies shoes dpth i |
5,122 |
2,260 |
$201K |
| A4927 |
Non-sterile gloves |
10,845 |
10,546 |
$165K |
| L3221 |
Orthopedic mens shoes dpth i |
3,797 |
1,694 |
$153K |
| A6530 |
Compression stocking bk18-30 |
2,479 |
1,543 |
$134K |
| B4150 |
Ef complet w/intact nutrient |
2,026 |
1,985 |
$131K |
| A6533 |
Gc stocking thighlngth 18-30 |
1,198 |
831 |
$106K |
| A4670 |
Automatic bp monitor, dial |
1,989 |
1,842 |
$50K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
430 |
386 |
$42K |
| E0570 |
Nebulizer with compression |
2,081 |
2,002 |
$28K |
| L1820 |
Ko elas w/ condyle pads & jo |
755 |
352 |
$24K |
| A6539 |
Gc stocking waistlngth 18-30 |
171 |
159 |
$21K |
| L3217 |
Ladies shoes hightop depth i |
384 |
179 |
$18K |
| A5500 |
Diab shoe for density insert |
1,725 |
533 |
$18K |
| T4525 |
Adult size pull-on sm |
163 |
152 |
$15K |
| E0143 |
Walker folding wheeled w/o s |
466 |
382 |
$13K |
| L3222 |
Mens shoes hightop depth inl |
174 |
84 |
$9K |
| A7005 |
Nondisposable nebulizer set |
394 |
377 |
$3K |
| A5513 |
Multi den insert custom mold |
362 |
78 |
$2K |
| L3908 |
Who cock-up nonmolde pre ots |
68 |
41 |
$2K |
| E0156 |
Walker seat attachment |
331 |
254 |
$1K |
| E0245 |
Tub stool or bench |
15 |
13 |
$1K |
| L3202 |
Oxford w/ supinat/pronator c |
24 |
13 |
$1K |
| A5512 |
Multi den insert direct form |
393 |
150 |
$1K |
| E0100 |
Cane adjust/fixed with tip |
137 |
120 |
$903.70 |
| E0246 |
Transfer tub rail attachment |
14 |
12 |
$842.40 |
| K0195 |
Elevating whlchair leg rests |
114 |
114 |
$731.53 |
| A7015 |
Aerosol mask used w nebulize |
380 |
363 |
$321.83 |
| A6402 |
Sterile gauze <= 16 sq in |
12 |
12 |
$144.60 |
| T4535 |
Disposable liner/shield/pad |
59 |
56 |
$88.20 |
| A4663 |
Dialysis blood pressure cuff |
12 |
12 |
$15.00 |