| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0652 |
Pneum compres w/cal pressure |
130 |
129 |
$563K |
| A4253 |
Blood glucose/reagent strips |
6,225 |
5,917 |
$165K |
| A5513 |
Multi den insert custom mold |
1,211 |
874 |
$81K |
| A4245 |
Alcohol wipes per box |
6,081 |
5,794 |
$67K |
| A5500 |
Diab shoe for density insert |
849 |
824 |
$53K |
| E0671 |
Pressure pneum appl full leg |
130 |
129 |
$50K |
| E0670 |
Seg pneum int legs/trunk |
42 |
41 |
$46K |
| A4259 |
Lancets per box |
6,222 |
5,917 |
$37K |
| A4256 |
Calibrator solution/chips |
6,232 |
5,925 |
$20K |
| E0651 |
Pneum compressor segmental |
24 |
24 |
$18K |
| K0553 |
Ther cgm supply allowance |
122 |
92 |
$8K |
| E0607 |
Blood glucose monitor home |
91 |
88 |
$3K |
| A4258 |
Lancet device each |
58 |
55 |
$11.02 |
| K0554 |
Ther cgm receiver/monitor |
14 |
14 |
$0.00 |