| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,774 |
6,709 |
$903K |
| A4554 |
Disposable underpads, all sizes |
10,591 |
10,494 |
$608K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
9,992 |
4,266 |
$406K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
5,929 |
2,425 |
$285K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,851 |
6,815 |
$256K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
7,602 |
7,548 |
$238K |
| L3410 |
Metatarsal bar wedge, between sole |
4,641 |
2,679 |
$222K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
2,978 |
1,272 |
$169K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
757 |
755 |
$145K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,923 |
4,884 |
$134K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,037 |
1,031 |
$94K |
| L3485 |
Heel, pad, removable for spur |
2,687 |
1,726 |
$78K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
416 |
393 |
$61K |
| L3340 |
Heel wedge, sach |
1,755 |
852 |
$50K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,279 |
3,248 |
$46K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
537 |
533 |
$37K |
| A4927 |
Gloves, non-sterile, per 100 |
7,881 |
7,806 |
$34K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
714 |
401 |
$27K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
699 |
349 |
$16K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
176 |
88 |
$15K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
583 |
199 |
$15K |
| A4670 |
Automatic blood pressure monitor |
314 |
312 |
$15K |
| 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 |
573 |
286 |
$12K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
763 |
322 |
$12K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
203 |
198 |
$10K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
136 |
98 |
$8K |
| 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 |
543 |
271 |
$8K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 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 |
36 |
36 |
$7K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
170 |
65 |
$5K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
72 |
72 |
$5K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
26 |
13 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
39 |
39 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
43 |
43 |
$1K |
| K0001 |
Standard wheelchair |
105 |
104 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13 |
13 |
$773.30 |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
13 |
12 |
$666.00 |
| E0156 |
Seat attachment, walker |
43 |
43 |
$349.65 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
12 |
$194.28 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
168 |
168 |
$187.27 |