| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
10,493 |
9,410 |
$944K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
9,514 |
8,468 |
$771K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
10,740 |
9,208 |
$737K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
5,543 |
4,975 |
$505K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,722 |
4,347 |
$405K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,673 |
2,546 |
$312K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
2,039 |
1,684 |
$275K |
| A4554 |
Disposable underpads, all sizes |
7,779 |
6,728 |
$271K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,298 |
1,197 |
$147K |
| A4927 |
Gloves, non-sterile, per 100 |
8,891 |
7,602 |
$103K |
| L3649 |
Orthopedic shoe, modification, addition or transfer, not otherwise specified |
2,079 |
1,400 |
$58K |
| E0570 |
Nebulizer, with compressor |
601 |
589 |
$48K |
| 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 |
1,532 |
926 |
$24K |
| 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 |
1,199 |
942 |
$21K |
| A4670 |
Automatic blood pressure monitor |
503 |
410 |
$20K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
165 |
163 |
$15K |
| E0245 |
Tub stool or bench |
355 |
284 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
592 |
584 |
$6K |
| 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 |
24 |
24 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
85 |
84 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
160 |
158 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,429 |
1,340 |
$660.42 |
| A7015 |
Aerosol mask, used with dme nebulizer |
590 |
582 |
$580.26 |
| E0156 |
Seat attachment, walker |
69 |
68 |
$329.60 |