| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
3,487 |
1,814 |
$273K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,749 |
3,747 |
$256K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,546 |
2,542 |
$255K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
2,524 |
1,305 |
$230K |
| A4554 |
Disposable underpads, all sizes |
5,254 |
5,250 |
$198K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,474 |
5,471 |
$192K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,923 |
1,170 |
$156K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
3,989 |
3,988 |
$116K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,839 |
2,839 |
$109K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
1,311 |
663 |
$106K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
669 |
335 |
$63K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
242 |
233 |
$21K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
97 |
97 |
$12K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
61 |
59 |
$6K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
129 |
129 |
$6K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
211 |
146 |
$5K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
20 |
20 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
830 |
830 |
$4K |