| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,314 |
1,669 |
$146K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,695 |
853 |
$44K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,326 |
666 |
$40K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
515 |
260 |
$16K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
521 |
520 |
$16K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
146 |
143 |
$12K |
| A4554 |
Disposable underpads, all sizes |
253 |
250 |
$10K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
189 |
189 |
$10K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
124 |
66 |
$8K |
| 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 |
84 |
84 |
$6K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
176 |
176 |
$5K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
197 |
97 |
$5K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
123 |
63 |
$5K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
200 |
98 |
$5K |
| L0642 |
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, off-the-shelf |
29 |
29 |
$2K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
98 |
49 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
79 |
78 |
$359.24 |