| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0575 |
Nebulizer ultrasonic |
560 |
479 |
$139K |
| A9274 |
Ext amb insulin delivery sys |
55 |
49 |
$118K |
| L3216 |
Orthoped ladies shoes dpth i |
2,206 |
863 |
$90K |
| S8101 |
Spacer with mask |
1,895 |
1,734 |
$74K |
| L2275 |
Plastic mod low ext pad/line |
1,418 |
541 |
$59K |
| T4523 |
Adult size brief/diaper lg |
1,226 |
524 |
$49K |
| A4554 |
Disposable underpads |
2,237 |
1,011 |
$35K |
| E0570 |
Nebulizer with compression |
395 |
369 |
$28K |
| L3020 |
Foot longitud/metatarsal sup |
296 |
132 |
$24K |
| E0784 |
Ext amb infusn pump insulin |
21 |
15 |
$22K |
| L3030 |
Foot arch support remov prem |
638 |
225 |
$21K |
| L3217 |
Ladies shoes hightop depth i |
469 |
140 |
$18K |
| A7005 |
Nondisposable nebulizer set |
2,254 |
2,083 |
$17K |
| T4524 |
Adult size brief/diaper xl |
324 |
131 |
$13K |
| A6530 |
Compression stocking bk18-30 |
190 |
116 |
$10K |
| S8100 |
Spacer without mask |
193 |
193 |
$9K |
| L3001 |
Foot insert remov molded spe |
128 |
43 |
$6K |
| L3221 |
Orthopedic mens shoes dpth i |
152 |
56 |
$6K |
| A5500 |
Diab shoe for density insert |
903 |
317 |
$2K |
| L3010 |
Foot longitudinal arch suppo |
24 |
12 |
$2K |
| K0001 |
Standard wheelchair |
165 |
110 |
$2K |
| A5512 |
Multi den insert direct form |
613 |
206 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$142.10 |
| E0156 |
Walker seat attachment |
12 |
12 |
$43.12 |