| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
633 |
576 |
$56K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
441 |
405 |
$54K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
272 |
152 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
698 |
632 |
$12K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
111 |
76 |
$9K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
88 |
74 |
$6K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
110 |
63 |
$6K |
| A4670 |
Automatic blood pressure monitor |
204 |
175 |
$4K |
| A4554 |
Disposable underpads, all sizes |
98 |
91 |
$4K |
| E0570 |
Nebulizer, with compressor |
110 |
99 |
$3K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
68 |
45 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
15 |
15 |
$2K |
| 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 |
57 |
26 |
$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 |
56 |
26 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
39 |
38 |
$328.68 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
26 |
24 |
$3.33 |