| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,661 |
1,983 |
$209K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,583 |
1,574 |
$63K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
893 |
468 |
$62K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
648 |
504 |
$56K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
843 |
432 |
$48K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
981 |
501 |
$27K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
374 |
372 |
$19K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
416 |
210 |
$17K |
| A4554 |
Disposable underpads, all sizes |
337 |
332 |
$9K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
87 |
87 |
$6K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
103 |
52 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
138 |
137 |
$620.17 |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
12 |
12 |
$218.12 |