| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
2,229 |
1,400 |
$107K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
1,976 |
1,580 |
$72K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,231 |
2,228 |
$61K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
838 |
649 |
$46K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
549 |
548 |
$43K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,541 |
1,541 |
$43K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
637 |
637 |
$30K |
| A4554 |
Disposable underpads, all sizes |
801 |
799 |
$27K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
1,466 |
852 |
$26K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
545 |
545 |
$19K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
298 |
204 |
$14K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
183 |
150 |
$13K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
111 |
68 |
$6K |
| L3224 |
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
181 |
99 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
742 |
742 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
66 |
33 |
$959.82 |
| L3225 |
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
49 |
26 |
$820.97 |