| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
8,303 |
4,422 |
$584K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
8,252 |
5,051 |
$575K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
4,520 |
2,795 |
$331K |
| E0570 |
Nebulizer, with compressor |
5,289 |
5,106 |
$319K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
2,104 |
1,245 |
$297K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,631 |
2,591 |
$266K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
4,666 |
4,331 |
$207K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,049 |
1,999 |
$176K |
| A4554 |
Disposable underpads, all sizes |
5,149 |
5,013 |
$170K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,155 |
1,069 |
$161K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,379 |
1,342 |
$149K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
616 |
564 |
$127K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,283 |
1,254 |
$100K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
792 |
755 |
$94K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
619 |
607 |
$84K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
860 |
798 |
$54K |
| A4927 |
Gloves, non-sterile, per 100 |
4,037 |
3,943 |
$45K |
| A4670 |
Automatic blood pressure monitor |
1,254 |
1,172 |
$42K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
425 |
421 |
$36K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
4,764 |
4,496 |
$36K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
373 |
231 |
$28K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
268 |
264 |
$22K |
| K0003 |
Lightweight wheelchair |
830 |
776 |
$21K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
195 |
195 |
$20K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
348 |
343 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
173 |
166 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,788 |
4,521 |
$4K |
| 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 |
963 |
544 |
$3K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
28 |
16 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
712 |
648 |
$2K |
| 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 |
821 |
474 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
85 |
85 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
39 |
37 |
$596.25 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
69 |
57 |
$529.91 |
| E0156 |
Seat attachment, walker |
15 |
13 |
$51.84 |