| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
431 |
341 |
$37K |
| A4554 |
Disposable underpads, all sizes |
793 |
772 |
$26K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
805 |
785 |
$24K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
272 |
263 |
$19K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
294 |
240 |
$17K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
329 |
314 |
$10K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
111 |
111 |
$8K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
90 |
67 |
$6K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
137 |
127 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
191 |
177 |
$822.55 |