| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
18,770 |
9,267 |
$1.20M |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
9,627 |
4,778 |
$692K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
7,970 |
3,949 |
$674K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
964 |
472 |
$246K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
1,209 |
1,202 |
$138K |
| A4554 |
Disposable underpads, all sizes |
1,374 |
1,365 |
$115K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
595 |
590 |
$106K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,344 |
1,336 |
$47K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
814 |
810 |
$45K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,169 |
570 |
$35K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,016 |
1,004 |
$33K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,266 |
1,252 |
$24K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
471 |
233 |
$21K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
821 |
809 |
$13K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
90 |
90 |
$11K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
191 |
95 |
$10K |
| L3410 |
Metatarsal bar wedge, between sole |
81 |
39 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
714 |
705 |
$3K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
32 |
14 |
$3K |
| L3485 |
Heel, pad, removable for spur |
48 |
24 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
817 |
810 |
$867.77 |