| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
16,208 |
9,362 |
$344K |
| A5512 |
Multi den insert direct form |
12,823 |
7,414 |
$247K |
| T4541 |
Large disposable underpad |
2,599 |
2,595 |
$184K |
| T4527 |
Adult size pull-on lg |
501 |
499 |
$73K |
| A5514 |
Mult den insert dir carv/cam |
2,388 |
1,244 |
$64K |
| A4239 |
Non-adju cgm supply allow |
544 |
539 |
$38K |
| T4526 |
Adult size pull-on med |
211 |
210 |
$31K |
| K0553 |
Ther cgm supply allowance |
590 |
588 |
$25K |
| B4152 |
Ef calorie dense>/=1.5kcal |
171 |
170 |
$24K |
| A5513 |
Multi den insert custom mold |
174 |
173 |
$11K |
| K0903 |
Mult den insert dir carv/cam |
230 |
230 |
$10K |
| T4535 |
Disposable liner/shield/pad |
82 |
82 |
$4K |
| E0607 |
Blood glucose monitor home |
231 |
231 |
$4K |
| 97803 |
|
34 |
32 |
$0.00 |