| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
4,008 |
2,160 |
$98K |
| T4535 |
Disposable liner/shield/pad |
2,139 |
1,921 |
$77K |
| A5512 |
Multi den insert direct form |
2,949 |
1,605 |
$66K |
| L3216 |
Orthoped ladies shoes dpth i |
731 |
608 |
$63K |
| L3030 |
Foot arch support remov prem |
639 |
528 |
$56K |
| L3020 |
Foot longitud/metatarsal sup |
208 |
191 |
$53K |
| L3221 |
Orthopedic mens shoes dpth i |
213 |
208 |
$33K |
| T4526 |
Adult size pull-on med |
288 |
284 |
$33K |
| T4541 |
Large disposable underpad |
505 |
486 |
$22K |
| A5513 |
Multi den insert custom mold |
90 |
52 |
$4K |
| A4927 |
Non-sterile gloves |
292 |
287 |
$3K |
| L3040 |
Ft arch suprt premold longit |
28 |
28 |
$2K |
| A6530 |
Compression stocking bk18-30 |
13 |
13 |
$1K |