| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
11,122 |
11,014 |
$601K |
| T4524 |
Adult size brief/diaper xl |
4,617 |
4,587 |
$575K |
| L3030 |
Foot arch support remov prem |
7,158 |
3,525 |
$468K |
| T4543 |
Adult disp brief/diap abv xl |
1,319 |
1,318 |
$357K |
| T4535 |
Disposable liner/shield/pad |
8,017 |
7,937 |
$344K |
| T4523 |
Adult size brief/diaper lg |
2,609 |
2,592 |
$259K |
| T4539 |
Reuse diaper/brief any size |
7,751 |
7,679 |
$232K |
| L3001 |
Foot insert remov molded spe |
2,061 |
1,030 |
$231K |
| L3217 |
Ladies shoes hightop depth i |
2,722 |
1,354 |
$215K |
| L3222 |
Mens shoes hightop depth inl |
1,366 |
681 |
$128K |
| T4537 |
Reusable underpad bed size |
4,753 |
4,704 |
$127K |
| L3216 |
Orthoped ladies shoes dpth i |
2,666 |
1,318 |
$118K |
| L3221 |
Orthopedic mens shoes dpth i |
1,776 |
873 |
$92K |
| L3410 |
Shoe metatarsal bar between |
748 |
369 |
$47K |
| T4522 |
Adult size brief/diaper med |
616 |
609 |
$44K |
| T4540 |
Reusable underpad chair size |
2,319 |
2,315 |
$31K |
| A4927 |
Non-sterile gloves |
6,956 |
6,864 |
$31K |
| L3485 |
Shoe heel pad removable for |
683 |
336 |
$23K |
| A4335 |
Incontinence supply |
2,660 |
2,656 |
$12K |
| A4670 |
Automatic bp monitor, dial |
106 |
106 |
$5K |
| A4402 |
Lubricant per ounce |
861 |
856 |
$4K |
| S8101 |
Spacer with mask |
29 |
29 |
$2K |
| L3340 |
Shoe wedge sach |
32 |
16 |
$2K |
| A6530 |
Compression stocking bk18-30 |
28 |
14 |
$653.76 |
| E0240 |
Bath/shower chair |
14 |
14 |
$539.42 |
| A7005 |
Nondisposable nebulizer set |
29 |
29 |
$474.15 |
| E1399 |
Durable medical equipment mi |
172 |
172 |
$468.01 |