| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
11,986 |
6,402 |
$810K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
2,726 |
1,404 |
$229K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
3,170 |
1,643 |
$227K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,465 |
6,447 |
$222K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,184 |
4,176 |
$208K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
1,713 |
874 |
$198K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
2,245 |
1,140 |
$178K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,496 |
2,488 |
$176K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
3,073 |
1,696 |
$149K |
| A4554 |
Disposable underpads, all sizes |
4,262 |
4,260 |
$133K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
950 |
530 |
$55K |
| 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 |
2,552 |
1,486 |
$46K |
| 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 |
2,539 |
1,477 |
$42K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,148 |
1,145 |
$35K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,027 |
991 |
$34K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
315 |
160 |
$30K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
745 |
744 |
$22K |
| A4500 |
Surgical stockings below knee length, each |
249 |
249 |
$12K |
| A4927 |
Gloves, non-sterile, per 100 |
1,841 |
1,833 |
$9K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
24 |
12 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
123 |
123 |
$930.90 |