| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
12,286 |
12,223 |
$863K |
| T4523 |
Adult size brief/diaper lg |
5,278 |
5,241 |
$728K |
| T4522 |
Adult size brief/diaper med |
5,816 |
5,791 |
$618K |
| T4524 |
Adult size brief/diaper xl |
3,103 |
3,092 |
$479K |
| T4533 |
Youth size brief/diaper |
1,832 |
1,822 |
$150K |
| L3020 |
Foot longitud/metatarsal sup |
582 |
582 |
$138K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
783 |
778 |
$79K |
| T4535 |
Disposable liner/shield/pad |
1,420 |
1,414 |
$66K |
| T4537 |
Reusable underpad bed size |
2,077 |
2,069 |
$64K |
| T4521 |
Adult size brief/diaper sm |
587 |
587 |
$50K |
| B4154 |
Ef spec metabolic noninherit |
205 |
200 |
$41K |
| A5072 |
Urinary pouch w/o barrier |
581 |
573 |
$41K |
| L3219 |
Orthopedic mens shoes oxford |
289 |
288 |
$31K |
| A6197 |
Alginate drsg >16 <=48 sq in |
213 |
211 |
$25K |
| T4540 |
Reusable underpad chair size |
1,382 |
1,378 |
$24K |
| A4351 |
Straight tip urine catheter |
194 |
192 |
$23K |
| A4373 |
Skin barrier with flange |
259 |
258 |
$19K |
| A5121 |
Solid skin barrier 6x6 |
198 |
194 |
$15K |
| A4927 |
Non-sterile gloves |
2,483 |
2,466 |
$10K |
| A6530 |
Compression stocking bk18-30 |
272 |
142 |
$8K |
| B4150 |
Ef complet w/intact nutrient |
53 |
53 |
$6K |
| A6205 |
Composite drsg > 48 sq in |
55 |
55 |
$4K |
| A4495 |
Thigh length surg stocking |
73 |
66 |
$4K |
| E0149 |
Heavy duty wheeled walker |
26 |
26 |
$4K |
| E0570 |
Nebulizer with compression |
87 |
87 |
$3K |
| L3485 |
Shoe heel pad removable for |
160 |
160 |
$3K |
| L3030 |
Foot arch support remov prem |
29 |
29 |
$3K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
58 |
58 |
$3K |
| E0240 |
Bath/shower chair |
64 |
64 |
$2K |
| A4670 |
Automatic bp monitor, dial |
38 |
38 |
$1K |
| A4660 |
Sphyg/bp app w cuff and stet |
83 |
83 |
$1K |
| A4500 |
Below knee surgical stocking |
34 |
27 |
$1K |
| E0241 |
Bath tub wall rail |
13 |
13 |
$559.80 |
| L3215 |
Orthopedic ftwear ladies oxf |
238 |
238 |
$505.43 |
| A7005 |
Nondisposable nebulizer set |
16 |
16 |
$261.60 |
| A7007 |
Lg vol nebulizer disposable |
16 |
16 |
$221.92 |
| E0156 |
Walker seat attachment |
12 |
12 |
$129.73 |
| L3230 |
Custom shoes depth inlay |
30 |
30 |
$73.29 |