| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
867 |
715 |
$364K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
411 |
342 |
$249K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
1,393 |
1,158 |
$211K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,745 |
1,224 |
$170K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
1,516 |
1,276 |
$143K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,236 |
910 |
$130K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
68 |
62 |
$112K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,924 |
1,660 |
$111K |
| L2280 |
Addition to lower extremity, molded inner boot |
238 |
183 |
$103K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
340 |
329 |
$91K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,341 |
1,049 |
$81K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
712 |
593 |
$80K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
887 |
728 |
$57K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
369 |
226 |
$37K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,070 |
1,003 |
$31K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
613 |
543 |
$21K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
19 |
15 |
$13K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
168 |
137 |
$13K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
182 |
138 |
$11K |
| E1002 |
Wheelchair accessory, power seating system, tilt only |
13 |
12 |
$11K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
84 |
69 |
$8K |
| K0040 |
Adjustable angle footplate, each |
54 |
38 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
14 |
12 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
37 |
26 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
15 |
12 |
$1K |
| K0004 |
High strength, lightweight wheelchair |
99 |
99 |
$1K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
15 |
12 |
$687.91 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
28 |
27 |
$641.92 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
17 |
13 |
$567.12 |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
14 |
12 |
$540.80 |