| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
1,611 |
815 |
$129K |
| L3410 |
Metatarsal bar wedge, between sole |
2,591 |
1,310 |
$119K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,986 |
1,004 |
$95K |
| L3390 |
Outflare wedge |
3,545 |
1,793 |
$88K |
| L3485 |
Heel, pad, removable for spur |
2,120 |
1,068 |
$52K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
982 |
495 |
$24K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
957 |
483 |
$24K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
517 |
511 |
$19K |
| L3340 |
Heel wedge, sach |
454 |
232 |
$15K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
309 |
301 |
$15K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
219 |
110 |
$15K |
| L3207 |
Orthopedic shoe, hightop with supinator or pronator, junior |
587 |
298 |
$15K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
250 |
126 |
$14K |
| E0570 |
Nebulizer, with compressor |
127 |
127 |
$11K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
171 |
171 |
$7K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
222 |
112 |
$7K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
157 |
79 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
105 |
105 |
$1K |