| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Grad com garm noc day use |
239 |
182 |
$257K |
| A6530 |
Compression stocking bk18-30 |
334 |
243 |
$23K |
| A6533 |
Gc stocking thighlngth 18-30 |
171 |
135 |
$19K |
| A6593 |
Grad com accessory gmt_wrap |
227 |
107 |
$16K |
| A5500 |
Diab shoe for density insert |
227 |
176 |
$10K |
| A6539 |
Gc stocking waistlngth 18-30 |
21 |
19 |
$6K |
| A6583 |
Grad com wrap w straps bk |
127 |
77 |
$6K |
| A5513 |
Multi den insert custom mold |
58 |
49 |
$4K |
| L3216 |
Orthoped ladies shoes dpth i |
27 |
25 |
$2K |
| A6545 |
Grad com non-elastic bk surg |
28 |
12 |
$2K |
| L2275 |
Plastic mod low ext pad/line |
12 |
12 |
$695.95 |
| A5512 |
Multi den insert direct form |
17 |
13 |
$675.07 |
| L2820 |
Soft interface below knee se |
12 |
12 |
$498.80 |