| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,350 |
1,284 |
$142K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,146 |
1,103 |
$95K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,723 |
876 |
$66K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
557 |
534 |
$62K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
240 |
195 |
$18K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
36 |
35 |
$4K |
| A4554 |
Disposable underpads, all sizes |
128 |
125 |
$4K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
37 |
37 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
291 |
286 |
$2K |
| A4670 |
Automatic blood pressure monitor |
30 |
28 |
$1K |