| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
6,659 |
6,639 |
$1.16M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
7,680 |
7,623 |
$1.08M |
| A4554 |
Disposable underpads, all sizes |
16,681 |
16,455 |
$862K |
| L3410 |
Metatarsal bar wedge, between sole |
19,421 |
9,970 |
$834K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
13,848 |
6,349 |
$689K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
16,178 |
7,657 |
$671K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
6,177 |
2,919 |
$367K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
4,820 |
2,404 |
$346K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
2,660 |
2,634 |
$345K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,540 |
9,489 |
$332K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
11,545 |
11,433 |
$329K |
| L3340 |
Heel wedge, sach |
10,496 |
5,370 |
$322K |
| L3485 |
Heel, pad, removable for spur |
8,967 |
4,641 |
$210K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
7,186 |
7,116 |
$178K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
755 |
391 |
$144K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
4,637 |
4,584 |
$59K |
| A4927 |
Gloves, non-sterile, per 100 |
11,998 |
11,591 |
$44K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
405 |
404 |
$41K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
1,411 |
710 |
$32K |
| 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 |
125 |
124 |
$22K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
311 |
305 |
$22K |
| 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 |
382 |
223 |
$19K |
| A4670 |
Automatic blood pressure monitor |
446 |
443 |
$18K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
875 |
441 |
$18K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
619 |
309 |
$14K |
| L3390 |
Outflare wedge |
573 |
300 |
$13K |
| 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 |
874 |
437 |
$13K |
| 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 |
78 |
78 |
$12K |
| 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 |
791 |
397 |
$12K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
150 |
80 |
$7K |
| L1848 |
Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf |
24 |
14 |
$6K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
76 |
43 |
$3K |
| L3400 |
Metatarsal bar wedge, rocker |
167 |
87 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
135 |
135 |
$3K |
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
15 |
12 |
$3K |
| L1831 |
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
23 |
12 |
$3K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
24 |
24 |
$2K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
64 |
31 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
45 |
45 |
$1K |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$928.80 |
| E0156 |
Seat attachment, walker |
123 |
123 |
$804.60 |
| K0001 |
Standard wheelchair |
118 |
118 |
$570.21 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
144 |
144 |
$139.94 |