| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
54 |
27 |
$2K |
| L0648 |
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, off-the-shelf |
13 |
13 |
$2K |
| A4670 |
Automatic blood pressure monitor |
70 |
69 |
$1K |
| E0570 |
Nebulizer, with compressor |
113 |
111 |
$1K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
112 |
110 |
$1K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
60 |
29 |
$1K |
| A4554 |
Disposable underpads, all sizes |
30 |
28 |
$248.00 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$196.07 |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
24 |
12 |
$194.72 |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
18 |
12 |
$144.99 |
| A7015 |
Aerosol mask, used with dme nebulizer |
112 |
110 |
$93.16 |