| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
5,434 |
5,404 |
$273K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
790 |
386 |
$191K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,305 |
2,293 |
$190K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,892 |
3,883 |
$170K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,798 |
1,796 |
$162K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
880 |
804 |
$121K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,879 |
1,872 |
$119K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
615 |
406 |
$30K |
| 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 |
809 |
544 |
$29K |
| E0601 |
Continuous positive airway pressure (cpap) device |
343 |
341 |
$27K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
715 |
712 |
$23K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
480 |
441 |
$22K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
318 |
197 |
$18K |
| 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 |
662 |
454 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
3,414 |
3,383 |
$14K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
132 |
127 |
$10K |
| E1399 |
Durable medical equipment, miscellaneous |
675 |
675 |
$8K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
306 |
304 |
$8K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
137 |
136 |
$4K |
| A7030 |
Full face mask used with positive airway pressure device, each |
54 |
54 |
$4K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
42 |
25 |
$3K |
| 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 |
14 |
14 |
$3K |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
12 |
12 |
$2K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
91 |
91 |
$2K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
15 |
15 |
$2K |
| L3370 |
Sole wedge, between sole |
41 |
41 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
32 |
31 |
$1K |
| E0241 |
Bath tub wall rail, each |
12 |
12 |
$389.81 |