| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4575 |
Topical hyperbaric oxygen chamber, disposable |
220 |
185 |
$1.04M |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
4,597 |
2,276 |
$643K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
716 |
676 |
$115K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,762 |
870 |
$80K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,456 |
717 |
$59K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
975 |
934 |
$38K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
1,286 |
652 |
$26K |
| E0602 |
Breast pump, manual, any type |
748 |
715 |
$23K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
198 |
155 |
$22K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
75 |
71 |
$21K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
182 |
158 |
$18K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
157 |
140 |
$11K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
264 |
221 |
$7K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
18 |
18 |
$1K |
| L3480 |
Heel, pad and depression for spur |
28 |
14 |
$705.88 |