| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,155 |
1,067 |
$44K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
650 |
280 |
$36K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
256 |
118 |
$10K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
262 |
246 |
$8K |
| 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 |
25 |
15 |
$2K |
| A4554 |
Disposable underpads, all sizes |
28 |
24 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
58 |
52 |
$233.95 |