| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,962 |
1,976 |
$253K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,627 |
1,608 |
$170K |
| A4554 |
Disposable underpads, all sizes |
4,179 |
4,148 |
$165K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,835 |
3,802 |
$108K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
2,444 |
1,217 |
$104K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,502 |
1,497 |
$104K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,036 |
512 |
$52K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,645 |
1,623 |
$45K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
430 |
428 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
974 |
956 |
$4K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
134 |
133 |
$4K |
| 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 |
90 |
46 |
$1K |
| 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 |
91 |
47 |
$1K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
27 |
26 |
$517.72 |