| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
8,918 |
4,733 |
$764K |
| E0575 |
Nebulizer, ultrasonic, large volume |
1,980 |
1,980 |
$601K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,767 |
2,261 |
$346K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,985 |
2,003 |
$190K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
2,847 |
1,569 |
$181K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
430 |
430 |
$180K |
| E0570 |
Nebulizer, with compressor |
1,648 |
1,647 |
$139K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
1,823 |
1,018 |
$138K |
| 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 |
2,488 |
1,328 |
$131K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
4,192 |
2,201 |
$109K |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
3,741 |
1,916 |
$97K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
639 |
460 |
$90K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
1,219 |
682 |
$75K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
844 |
474 |
$61K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,200 |
617 |
$53K |
| 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 |
2,349 |
1,253 |
$53K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
1,731 |
1,709 |
$43K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
160 |
114 |
$39K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
625 |
323 |
$33K |
| 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 |
125 |
125 |
$31K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
268 |
159 |
$31K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
1,176 |
605 |
$30K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,735 |
1,712 |
$25K |
| 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 |
98 |
98 |
$20K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
99 |
65 |
$13K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
594 |
309 |
$11K |
| 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 |
97 |
74 |
$9K |
| A4670 |
Automatic blood pressure monitor |
102 |
101 |
$4K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
55 |
55 |
$3K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
13 |
12 |
$2K |