| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
46,072 |
24,593 |
$2.94M |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
24,397 |
12,997 |
$1.07M |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
18,531 |
9,796 |
$955K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
3,660 |
1,890 |
$412K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
2,821 |
1,446 |
$213K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
2,313 |
1,173 |
$206K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
2,532 |
1,341 |
$171K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
1,819 |
951 |
$144K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,987 |
2,090 |
$102K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
621 |
616 |
$54K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
945 |
944 |
$52K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,618 |
1,613 |
$48K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
1,164 |
570 |
$47K |
| A4554 |
Disposable underpads, all sizes |
1,114 |
1,109 |
$34K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,349 |
1,345 |
$33K |
| 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 |
279 |
224 |
$20K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
822 |
818 |
$15K |
| 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 |
266 |
208 |
$10K |
| L3070 |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
28 |
16 |
$833.00 |