| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
906 |
709 |
$43K |
| A5514 |
Mult den insert dir carv/cam |
1,856 |
806 |
$38K |
| A5500 |
Diab shoe for density insert |
3,399 |
1,418 |
$26K |
| K0553 |
Ther cgm supply allowance |
1,594 |
1,241 |
$16K |
| A4253 |
Blood glucose/reagent strips |
3,362 |
2,881 |
$13K |
| A5512 |
Multi den insert direct form |
805 |
318 |
$6K |
| A5513 |
Multi den insert custom mold |
205 |
89 |
$4K |
| A4259 |
Lancets per box |
2,489 |
2,136 |
$1K |
| A4256 |
Calibrator solution/chips |
529 |
466 |
$167.87 |
| A4233 |
Alkalin batt for glucose mon |
84 |
70 |
$31.26 |
| A4258 |
Lancet device each |
146 |
137 |
$22.81 |