| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,760 |
6,669 |
$923K |
| A4554 |
Disposable underpads, all sizes |
11,128 |
10,999 |
$660K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,031 |
2,031 |
$506K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,819 |
8,721 |
$351K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
10,365 |
10,234 |
$336K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
5,487 |
2,704 |
$276K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
3,484 |
1,696 |
$225K |
| L3410 |
Metatarsal bar wedge, between sole |
4,474 |
2,287 |
$212K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,450 |
5,394 |
$157K |
| L3340 |
Heel wedge, sach |
3,581 |
1,839 |
$117K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
909 |
453 |
$101K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
1,304 |
643 |
$93K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
898 |
895 |
$89K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,493 |
3,460 |
$51K |
| A4927 |
Gloves, non-sterile, per 100 |
9,935 |
9,824 |
$45K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
520 |
520 |
$39K |
| L3485 |
Heel, pad, removable for spur |
1,074 |
543 |
$30K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
955 |
476 |
$25K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
1,062 |
531 |
$24K |
| A4670 |
Automatic blood pressure monitor |
430 |
427 |
$21K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
426 |
207 |
$12K |
| L3390 |
Outflare wedge |
411 |
210 |
$10K |
| 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 |
552 |
277 |
$8K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
73 |
73 |
$7K |
| 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 |
177 |
94 |
$7K |
| 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 |
534 |
268 |
$7K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
38 |
38 |
$6K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
55 |
54 |
$5K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
24 |
13 |
$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 |
40 |
40 |
$4K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
116 |
63 |
$4K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
82 |
41 |
$3K |
| 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 |
14 |
14 |
$2K |
| K0001 |
Standard wheelchair |
91 |
91 |
$602.35 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
15 |
15 |
$526.60 |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
18 |
18 |
$499.50 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
18 |
18 |
$292.22 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
109 |
109 |
$133.58 |