| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
8,696 |
8,655 |
$449K |
| L3030 |
Foot arch support remov prem |
6,722 |
3,425 |
$389K |
| T4523 |
Adult size brief/diaper lg |
3,658 |
3,630 |
$335K |
| T4535 |
Disposable liner/shield/pad |
8,390 |
8,353 |
$259K |
| L3217 |
Ladies shoes hightop depth i |
3,631 |
1,789 |
$238K |
| T4524 |
Adult size brief/diaper xl |
2,471 |
2,453 |
$219K |
| T4539 |
Reuse diaper/brief any size |
6,194 |
6,151 |
$179K |
| T4537 |
Reusable underpad bed size |
4,353 |
4,323 |
$111K |
| L3222 |
Mens shoes hightop depth inl |
1,315 |
651 |
$104K |
| L3410 |
Shoe metatarsal bar between |
2,233 |
1,102 |
$101K |
| L3002 |
Foot insert plastazote or eq |
1,026 |
506 |
$101K |
| L3216 |
Orthoped ladies shoes dpth i |
1,608 |
964 |
$72K |
| T4522 |
Adult size brief/diaper med |
1,122 |
1,120 |
$69K |
| T4543 |
Adult disp brief/diap abv xl |
371 |
369 |
$62K |
| L3310 |
Shoe lift elev heel/sole neo |
866 |
426 |
$41K |
| L3221 |
Orthopedic mens shoes dpth i |
691 |
430 |
$39K |
| E0570 |
Nebulizer with compression |
413 |
413 |
$32K |
| L3340 |
Shoe wedge sach |
885 |
442 |
$30K |
| A4927 |
Non-sterile gloves |
6,882 |
6,840 |
$27K |
| T4540 |
Reusable underpad chair size |
1,994 |
1,984 |
$27K |
| A6540 |
Gc stocking waistlngth 30-40 |
124 |
122 |
$17K |
| L3219 |
Orthopedic mens shoes oxford |
145 |
72 |
$11K |
| A4670 |
Automatic bp monitor, dial |
237 |
237 |
$10K |
| S8101 |
Spacer with mask |
217 |
217 |
$10K |
| A6530 |
Compression stocking bk18-30 |
245 |
128 |
$5K |
| A7005 |
Nondisposable nebulizer set |
186 |
186 |
$2K |
| A5500 |
Diab shoe for density insert |
73 |
37 |
$1K |
| A5512 |
Multi den insert direct form |
77 |
39 |
$1K |