| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,686 |
3,631 |
$177K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,576 |
1,555 |
$175K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,673 |
2,635 |
$95K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,420 |
697 |
$70K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
642 |
638 |
$59K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,662 |
1,618 |
$47K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
724 |
715 |
$31K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
737 |
721 |
$17K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
174 |
86 |
$11K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
194 |
98 |
$11K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
203 |
203 |
$9K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
80 |
38 |
$6K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
137 |
69 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
565 |
545 |
$2K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
27 |
27 |
$1K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
33 |
32 |
$451.83 |