| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
4,008 |
2,160 |
$98K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,139 |
1,921 |
$77K |
| 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 |
2,949 |
1,605 |
$66K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
731 |
608 |
$63K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
639 |
528 |
$56K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
208 |
191 |
$53K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
213 |
208 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
288 |
284 |
$33K |
| T4541 |
Incontinence product, disposable underpad, large, each |
505 |
486 |
$22K |
| 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 |
90 |
52 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
292 |
287 |
$3K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
28 |
28 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
13 |
13 |
$1K |