| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
7,492 |
7,363 |
$1.08M |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,877 |
1,172 |
$371K |
| L0631 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 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 |
1,223 |
1,161 |
$336K |
| A4554 |
Disposable underpads, all sizes |
7,163 |
7,042 |
$335K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,116 |
1,375 |
$170K |
| A4927 |
Gloves, non-sterile, per 100 |
6,995 |
6,872 |
$119K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
2,375 |
1,099 |
$103K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
2,404 |
1,075 |
$88K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
438 |
250 |
$66K |
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
581 |
397 |
$64K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
1,161 |
551 |
$54K |
| E0570 |
Nebulizer, with compressor |
682 |
586 |
$43K |
| E0147 |
Walker, heavy duty, multiple braking system, variable wheel resistance |
404 |
357 |
$39K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
844 |
364 |
$34K |
| L0180 |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
178 |
169 |
$25K |
| A4670 |
Automatic blood pressure monitor |
992 |
932 |
$21K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
450 |
346 |
$19K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
575 |
510 |
$9K |
| E0245 |
Tub stool or bench |
81 |
80 |
$7K |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
77 |
46 |
$5K |
| K0001 |
Standard wheelchair |
187 |
148 |
$3K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
59 |
30 |
$3K |
| E2612 |
General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware |
16 |
16 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
67 |
60 |
$3K |
| E2602 |
General use wheelchair seat cushion, width 22 inches or greater, any depth |
29 |
28 |
$1K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
28 |
15 |
$1K |
| L3675 |
Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf |
19 |
16 |
$1K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
294 |
215 |
$953.90 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
13 |
12 |
$298.86 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
16 |
16 |
$273.09 |
| K0002 |
Standard hemi (low seat) wheelchair |
26 |
24 |
$181.07 |
| A7015 |
Aerosol mask, used with dme nebulizer |
296 |
216 |
$147.11 |