| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,343 |
7,170 |
$909K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
11,309 |
4,547 |
$530K |
| A4554 |
Disposable underpads, all sizes |
12,611 |
12,260 |
$489K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,610 |
2,556 |
$301K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,133 |
3,071 |
$301K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
5,122 |
2,260 |
$201K |
| A4927 |
Gloves, non-sterile, per 100 |
10,845 |
10,546 |
$165K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
3,797 |
1,694 |
$153K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,479 |
1,543 |
$134K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,026 |
1,985 |
$131K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
1,198 |
831 |
$106K |
| A4670 |
Automatic blood pressure monitor |
1,989 |
1,842 |
$50K |
| 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 |
430 |
386 |
$42K |
| E0570 |
Nebulizer, with compressor |
2,081 |
2,002 |
$28K |
| 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 |
755 |
352 |
$24K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
171 |
159 |
$21K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
384 |
179 |
$18K |
| 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 |
1,725 |
533 |
$18K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
163 |
152 |
$15K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
466 |
382 |
$13K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
174 |
84 |
$9K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
394 |
377 |
$3K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
362 |
78 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
68 |
41 |
$2K |
| E0156 |
Seat attachment, walker |
331 |
254 |
$1K |
| E0245 |
Tub stool or bench |
15 |
13 |
$1K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
24 |
13 |
$1K |
| 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 |
393 |
150 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
137 |
120 |
$903.70 |
| E0246 |
Transfer tub rail attachment |
14 |
12 |
$842.40 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
114 |
114 |
$731.53 |
| A7015 |
Aerosol mask, used with dme nebulizer |
380 |
363 |
$321.83 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$144.60 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
59 |
56 |
$88.20 |
| A4663 |
Blood pressure cuff only |
12 |
12 |
$15.00 |