| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4575 |
Hyperbaric o2 chamber disps |
1,643 |
1,529 |
$8.15M |
| L2275 |
Plastic mod low ext pad/line |
56,640 |
28,393 |
$4.11M |
| L3030 |
Foot arch support remov prem |
76,265 |
38,069 |
$3.68M |
| L3010 |
Foot longitudinal arch suppo |
39,651 |
19,896 |
$2.96M |
| A4554 |
Disposable underpads |
73,642 |
73,173 |
$2.82M |
| L3000 |
Ft insert ucb berkeley shell |
15,974 |
7,985 |
$2.79M |
| L3001 |
Foot insert remov molded spe |
35,360 |
17,691 |
$2.57M |
| T4524 |
Adult size brief/diaper xl |
25,067 |
24,818 |
$2.19M |
| L3215 |
Orthopedic ftwear ladies oxf |
39,616 |
19,871 |
$2.03M |
| L3410 |
Shoe metatarsal bar between |
44,725 |
22,375 |
$2.00M |
| L1971 |
Afo w/ankle joint, prefab |
10,193 |
5,167 |
$1.88M |
| A9276 |
Disposable sensor, cgm sys |
3,269 |
2,910 |
$1.87M |
| L3219 |
Orthopedic mens shoes oxford |
28,392 |
14,236 |
$1.71M |
| T4535 |
Disposable liner/shield/pad |
53,783 |
53,528 |
$1.63M |
| T4523 |
Adult size brief/diaper lg |
19,466 |
19,412 |
$1.52M |
| L1820 |
Ko elas w/ condyle pads & jo |
17,475 |
8,778 |
$1.30M |
| L3807 |
Whfo w/o joints pre cst |
9,004 |
4,617 |
$1.05M |
| L3370 |
Shoe sole wedge between sole |
43,518 |
21,760 |
$1.04M |
| L3216 |
Orthoped ladies shoes dpth i |
30,358 |
15,282 |
$1.02M |
| L2330 |
Lacer molded to patient mode |
3,423 |
1,711 |
$1.01M |
| L1907 |
Afo supramalleolar custom |
3,428 |
1,713 |
$969K |
| T4539 |
Reuse diaper/brief any size |
36,834 |
36,523 |
$800K |
| L3809 |
Whfo w/o joints pre ots |
7,226 |
3,655 |
$747K |
| L3002 |
Foot insert plastazote or eq |
9,857 |
4,929 |
$746K |
| L3217 |
Ladies shoes hightop depth i |
12,422 |
6,160 |
$680K |
| T4543 |
Adult disp brief/diap abv xl |
3,594 |
3,538 |
$658K |
| T4537 |
Reusable underpad bed size |
25,092 |
24,882 |
$642K |
| L3485 |
Shoe heel pad removable for |
24,617 |
12,316 |
$585K |
| L3221 |
Orthopedic mens shoes dpth i |
14,610 |
7,305 |
$552K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
2,654 |
2,649 |
$499K |
| T4522 |
Adult size brief/diaper med |
8,165 |
8,099 |
$496K |
| L3222 |
Mens shoes hightop depth inl |
7,634 |
3,792 |
$484K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
2,274 |
2,269 |
$483K |
| L3060 |
Foot arch supp longitud/meta |
12,701 |
6,362 |
$413K |
| L2112 |
Afo tibial fracture soft |
1,717 |
1,714 |
$403K |
| E0603 |
Electric breast pump |
3,463 |
3,458 |
$398K |
| L3202 |
Oxford w/ supinat/pronator c |
16,148 |
8,083 |
$386K |
| L1906 |
Afo multilig ank sup pre ots |
6,653 |
3,355 |
$332K |
| A9277 |
External transmitter, cgm |
587 |
510 |
$311K |
| L3710 |
Eo elas w/metal jnts pre ots |
5,844 |
2,930 |
$304K |
| L3206 |
Hightop w/ supp/pronator chi |
10,885 |
5,450 |
$258K |
| L1930 |
Afo plastic |
1,545 |
843 |
$215K |
| E1390 |
Oxygen concentrator |
2,357 |
2,348 |
$197K |
| L3480 |
Shoe heel pad & depress for |
12,929 |
6,522 |
$194K |
| E0570 |
Nebulizer with compression |
2,359 |
2,329 |
$184K |
| L0648 |
Lso sag r an/pos pnl pre ots |
396 |
390 |
$182K |
| L3390 |
Shoe outflare wedge |
7,520 |
3,767 |
$179K |
| B4154 |
Ef spec metabolic noninherit |
580 |
527 |
$173K |
| T4521 |
Adult size brief/diaper sm |
2,714 |
2,700 |
$162K |
| A4927 |
Non-sterile gloves |
43,379 |
42,937 |
$159K |
| A4230 |
Infus insulin pump non needl |
158 |
142 |
$154K |
| L3808 |
Whfo, rigid w/o joints |
701 |
351 |
$141K |
| L3702 |
Eo w/o joints cf |
885 |
450 |
$133K |
| T4533 |
Youth size brief/diaper |
2,230 |
2,213 |
$128K |
| B4150 |
Ef complet w/intact nutrient |
801 |
744 |
$125K |
| L3170 |
Foot plas heel stabi pre ots |
4,946 |
2,473 |
$119K |
| A6539 |
Gc stocking waistlngth 18-30 |
1,422 |
733 |
$114K |
| L3040 |
Ft arch suprt premold longit |
3,680 |
1,930 |
$105K |
| T4527 |
Adult size pull-on lg |
1,173 |
1,123 |
$104K |
| L3320 |
Shoe lift elev heel/sole cor |
2,150 |
1,093 |
$103K |
| L2300 |
Abduction bar jointed adjust |
511 |
500 |
$97K |
| E0601 |
Cont airway pressure device |
344 |
340 |
$97K |
| L4396 |
Static or dynami afo pre cst |
922 |
471 |
$93K |
| L3400 |
Shoe metatarsal bar wedge ro |
4,672 |
2,332 |
$90K |
| L2630 |
Pelvic control band & belt u |
492 |
492 |
$81K |
| E0575 |
Nebulizer ultrasonic |
256 |
256 |
$76K |
| A4232 |
Syringe w/needle insulin 3cc |
214 |
190 |
$75K |
| L3310 |
Shoe lift elev heel/sole neo |
1,530 |
767 |
$73K |
| A6530 |
Compression stocking bk18-30 |
2,714 |
1,402 |
$73K |
| A7030 |
Cpap full face mask |
875 |
872 |
$73K |
| T4540 |
Reusable underpad chair size |
6,438 |
6,406 |
$72K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
160 |
160 |
$71K |
| A4351 |
Straight tip urine catheter |
1,144 |
1,119 |
$70K |
| L3003 |
Foot insert silicone gel eac |
900 |
450 |
$69K |
| L2755 |
Carbon graphite lamination |
1,510 |
755 |
$60K |
| L3420 |
Full sole/heel wedge btween |
2,160 |
1,080 |
$57K |
| L2114 |
Afo tib fx semi-rigid |
219 |
218 |
$56K |
| L3340 |
Shoe wedge sach |
1,719 |
862 |
$54K |
| A5500 |
Diab shoe for density insert |
1,236 |
618 |
$54K |
| L3050 |
Foot arch supp premold metat |
1,855 |
928 |
$49K |
| L3760 |
Eo adj jt prefab custom fit |
284 |
142 |
$45K |
| L1833 |
Ko adj jnt pos r sup pre ots |
124 |
72 |
$40K |
| E0562 |
Humidifier heated used w pap |
437 |
430 |
$37K |
| L2768 |
Ortho sidebar disconnect |
520 |
260 |
$33K |
| L3207 |
Hightop w/ supp/pronator jun |
1,264 |
634 |
$30K |
| S8101 |
Spacer with mask |
1,062 |
1,061 |
$29K |
| L0621 |
Sio flex pelvic/sacr pre ots |
566 |
564 |
$26K |
| E0143 |
Walker folding wheeled w/o s |
529 |
528 |
$26K |
| L1850 |
Ko swedish type pre ots |
131 |
110 |
$24K |
| A6533 |
Gc stocking thighlngth 18-30 |
701 |
633 |
$23K |
| E0431 |
Portable gaseous 02 |
1,209 |
1,197 |
$21K |
| A7005 |
Nondisposable nebulizer set |
1,891 |
1,890 |
$21K |
| L3908 |
Who cock-up nonmolde pre ots |
603 |
586 |
$20K |
| A4239 |
Non-adju cgm supply allow |
248 |
242 |
$20K |
| A6540 |
Gc stocking waistlngth 30-40 |
160 |
160 |
$19K |
| L3360 |
Shoe sole wedge outside sole |
1,230 |
615 |
$19K |
| A5513 |
Multi den insert custom mold |
600 |
302 |
$18K |
| L3762 |
Eo rigid w/o joints pre ots |
383 |
194 |
$18K |
| K0553 |
Ther cgm supply allowance |
122 |
122 |
$18K |
| E0190 |
Positioning cushion |
1,306 |
1,305 |
$17K |
| L3100 |
Hallus-valgus nt dyn pre ots |
586 |
294 |
$16K |
| A7035 |
Pos airway press headgear |
1,605 |
1,602 |
$14K |
| A6196 |
Alginate dressing <=16 sq in |
171 |
164 |
$13K |
| L1920 |
Afo sing upright w/ adjust s |
86 |
43 |
$13K |
| L3430 |
Sho heel count plast reinfor |
4,245 |
2,122 |
$13K |
| A4670 |
Automatic bp monitor, dial |
278 |
278 |
$12K |
| L3916 |
Who nontorsion jnts pre ots |
52 |
38 |
$11K |
| A4456 |
Adhesive remover, wipes |
1,239 |
1,239 |
$11K |
| A7037 |
Pos airway pressure tubing |
2,073 |
2,068 |
$11K |
| A5512 |
Multi den insert direct form |
467 |
235 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
1,227 |
1,204 |
$10K |
| L2116 |
Afo tibial fracture rigid |
36 |
36 |
$10K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
263 |
254 |
$10K |
| E0240 |
Bath/shower chair |
209 |
208 |
$10K |
| K0001 |
Standard wheelchair |
364 |
360 |
$9K |
| L3332 |
Shoe lifts tapered to one-ha |
239 |
239 |
$9K |
| L1910 |
Afo sing bar clasp attach sh |
84 |
42 |
$8K |
| L0170 |
Cervical collar molded to pt |
37 |
37 |
$8K |
| A9278 |
External receiver, cgm sys |
47 |
47 |
$7K |
| L1836 |
Ko rigid w/o joints pre ots |
64 |
64 |
$7K |
| A6446 |
Conform band s w>=3" <5"/yd |
889 |
870 |
$6K |
| A4353 |
Intermittent urinary cath |
54 |
52 |
$6K |
| K1005 |
Disp col sto bag breast milk |
226 |
226 |
$5K |
| A7034 |
Nasal application device |
162 |
162 |
$5K |
| A7031 |
Replacement facemask interfa |
408 |
408 |
$5K |
| A7038 |
Pos airway pressure filter |
2,321 |
2,314 |
$4K |
| L1831 |
Knee orth pos locking joint |
30 |
15 |
$4K |
| L0180 |
Cer post col occ/man sup adj |
29 |
28 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
496 |
483 |
$4K |
| L3960 |
Sewho airplan desig abdu pos |
12 |
12 |
$3K |
| E0656 |
Segmental pneumatic trunk |
273 |
273 |
$3K |
| E0990 |
Wheelchair elevating leg res |
32 |
32 |
$3K |
| T4530 |
Ped size brief/diaper lg |
64 |
63 |
$2K |
| L1902 |
Afo ankle gauntlet pre ots |
63 |
51 |
$2K |
| A4402 |
Lubricant per ounce |
470 |
470 |
$2K |
| E0973 |
W/ch access det adj armrest |
44 |
44 |
$1K |
| E0114 |
Crutch underarm pair no wood |
92 |
92 |
$1K |
| E0242 |
Bath tub rail floor |
21 |
17 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
79 |
77 |
$1K |
| A4450 |
Non-waterproof tape |
417 |
415 |
$1K |
| E0156 |
Walker seat attachment |
80 |
80 |
$1K |
| E0550 |
Humidif extens supple w ippb |
12 |
12 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
1,311 |
1,286 |
$925.70 |
| A7039 |
Filter, non disposable w pap |
660 |
659 |
$859.33 |
| E0445 |
Oximeter non-invasive |
17 |
16 |
$841.52 |
| A4614 |
Hand-held pefr meter |
63 |
63 |
$827.60 |
| A4452 |
Waterproof tape |
145 |
145 |
$774.98 |
| A7010 |
Disposable corrugated tubing |
85 |
62 |
$769.23 |
| A4253 |
Blood glucose/reagent strips |
65 |
65 |
$762.94 |
| L3660 |
So 8 ab rstr can/web pre ots |
25 |
25 |
$670.00 |
| L3203 |
Oxford w/ supinator/pronator |
28 |
14 |
$656.60 |
| L3070 |
Arch suprt att to sho longit |
32 |
16 |
$601.28 |
| A6212 |
Foam drg <=16 sq in w/border |
28 |
26 |
$598.49 |
| E0215 |
Electric heat pad moist |
45 |
45 |
$593.72 |
| E0604 |
Hosp grade elec breast pump |
27 |
26 |
$543.27 |
| A4565 |
Slings |
133 |
132 |
$523.48 |
| E0971 |
Wheelchair anti-tipping devi |
17 |
17 |
$457.30 |
| E0241 |
Bath tub wall rail |
18 |
17 |
$437.24 |
| L2810 |
Knee control condylar pad |
20 |
12 |
$294.00 |
| E0730 |
Tens four lead |
13 |
13 |
$258.00 |
| A6216 |
Non-sterile gauze<=16 sq in |
68 |
67 |
$208.76 |
| K0195 |
Elevating whlchair leg rests |
168 |
166 |
$207.93 |
| L3450 |
Shoe heel sach cushion type |
50 |
25 |
$151.00 |
| L3380 |
Shoe clubfoot wedge |
24 |
12 |
$140.76 |
| A7032 |
Replacement nasal cushion |
12 |
12 |
$122.75 |
| A7003 |
Nebulizer administration set |
92 |
91 |
$121.93 |
| A4259 |
Lancets per box |
25 |
25 |
$98.86 |
| A4557 |
Lead wires, pair |
12 |
12 |
$82.83 |
| E0961 |
Wheelchair brake extension |
16 |
16 |
$43.24 |
| A7013 |
Disposable compressor filter |
92 |
91 |
$5.99 |
| A7046 |
Repl water chamber, pap dev |
35 |
35 |
$1.62 |
| L4361 |
Pneuma/vac walk boot pre ots |
25 |
25 |
$0.00 |