| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
14,661 |
14,586 |
$416K |
| A4554 |
Disposable underpads |
10,563 |
10,522 |
$263K |
| L3030 |
Foot arch support remov prem |
2,800 |
1,934 |
$220K |
| T4523 |
Adult size brief/diaper lg |
2,940 |
2,921 |
$182K |
| T4522 |
Adult size brief/diaper med |
2,385 |
2,370 |
$111K |
| L3216 |
Orthoped ladies shoes dpth i |
1,786 |
1,250 |
$94K |
| T4524 |
Adult size brief/diaper xl |
1,507 |
1,500 |
$90K |
| T4539 |
Reuse diaper/brief any size |
2,608 |
2,582 |
$68K |
| T4537 |
Reusable underpad bed size |
1,382 |
1,372 |
$42K |
| L3221 |
Orthopedic mens shoes dpth i |
302 |
206 |
$18K |
| A4927 |
Non-sterile gloves |
2,657 |
2,631 |
$12K |
| A4670 |
Automatic bp monitor, dial |
143 |
143 |
$6K |
| A4253 |
Blood glucose/reagent strips |
64 |
64 |
$528.13 |
| A6530 |
Compression stocking bk18-30 |
21 |
12 |
$386.54 |