| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
25,645 |
13,112 |
$4.90M |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
12,057 |
5,902 |
$1.24M |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
17,329 |
8,667 |
$1.19M |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
18,012 |
9,069 |
$1.03M |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
8,644 |
4,482 |
$688K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
15,118 |
7,974 |
$662K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
6,796 |
3,473 |
$414K |
| L3480 |
Heel, pad and depression for spur |
25,908 |
13,019 |
$402K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
11,724 |
5,984 |
$295K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,204 |
6,184 |
$172K |
| L3410 |
Metatarsal bar wedge, between sole |
3,003 |
1,551 |
$152K |
| A4554 |
Disposable underpads, all sizes |
5,016 |
5,007 |
$143K |
| 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 |
3,519 |
1,820 |
$122K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,583 |
1,575 |
$116K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,498 |
1,495 |
$107K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
2,060 |
1,082 |
$84K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,654 |
854 |
$80K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
992 |
499 |
$76K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
1,159 |
685 |
$41K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,446 |
1,432 |
$41K |
| 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 |
2,475 |
1,298 |
$36K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
453 |
452 |
$28K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
219 |
159 |
$14K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
125 |
125 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
1,171 |
1,119 |
$4K |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
12 |
12 |
$4K |
| L3360 |
Sole wedge, outside sole |
76 |
38 |
$1K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
24 |
12 |
$966.02 |