| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,814 |
6,799 |
$600K |
| A4554 |
Disposable underpads, all sizes |
8,504 |
8,490 |
$387K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,421 |
3,416 |
$306K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
10,012 |
9,992 |
$268K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
8,090 |
8,081 |
$259K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,423 |
5,415 |
$189K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
4,087 |
2,043 |
$165K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
1,507 |
755 |
$69K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
359 |
179 |
$19K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
238 |
119 |
$7K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
52 |
26 |
$4K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
50 |
25 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
55 |
51 |
$236.60 |