| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,272 |
2,208 |
$91K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
502 |
266 |
$34K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
229 |
117 |
$10K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
186 |
184 |
$6K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
75 |
40 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
742 |
730 |
$3K |
| A4554 |
Disposable underpads, all sizes |
25 |
25 |
$1K |
| 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 |
12 |
12 |
$254.04 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
13 |
13 |
$23.27 |