| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose/reagent strips |
3,957 |
3,684 |
$20K |
| K0003 |
Lightweight wheelchair |
1,386 |
1,384 |
$13K |
| E0235 |
Paraffin bath unit portable |
1,303 |
1,301 |
$7K |
| A5500 |
Diab shoe for density insert |
2,659 |
1,557 |
$6K |
| A5512 |
Multi den insert direct form |
2,643 |
1,551 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
162 |
162 |
$3K |
| A4259 |
Lancets per box |
3,936 |
3,666 |
$2K |
| E0210 |
Electric heat pad standard |
132 |
132 |
$2K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
68 |
68 |
$2K |
| E0156 |
Walker seat attachment |
111 |
111 |
$777.94 |
| L0641 |
Lo rig pos pnl l1-l5 pre ots |
30 |
30 |
$646.37 |
| L1812 |
Ko elastic w/joints pre ots |
96 |
93 |
$635.36 |
| K0739 |
Repair/svc dme non-oxygen eq |
56 |
56 |
$369.54 |
| E0607 |
Blood glucose monitor home |
12 |
12 |
$99.70 |
| A4258 |
Lancet device each |
12 |
12 |
$7.10 |
| L4205 |
Ortho dvc repair per 15 min |
60 |
56 |
$0.00 |
| L4002 |
Replace strap, any orthosis |
60 |
56 |
$0.00 |
| L1820 |
Ko elas w/ condyle pads & jo |
23 |
13 |
$0.00 |