| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
8,696 |
8,655 |
$449K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
6,722 |
3,425 |
$389K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,658 |
3,630 |
$335K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,390 |
8,353 |
$259K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
3,631 |
1,789 |
$238K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,471 |
2,453 |
$219K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
6,194 |
6,151 |
$179K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,353 |
4,323 |
$111K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
1,315 |
651 |
$104K |
| L3410 |
Metatarsal bar wedge, between sole |
2,233 |
1,102 |
$101K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
1,026 |
506 |
$101K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,608 |
964 |
$72K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,122 |
1,120 |
$69K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
371 |
369 |
$62K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
866 |
426 |
$41K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
691 |
430 |
$39K |
| E0570 |
Nebulizer, with compressor |
413 |
413 |
$32K |
| L3340 |
Heel wedge, sach |
885 |
442 |
$30K |
| A4927 |
Gloves, non-sterile, per 100 |
6,882 |
6,840 |
$27K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,994 |
1,984 |
$27K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
124 |
122 |
$17K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
145 |
72 |
$11K |
| A4670 |
Automatic blood pressure monitor |
237 |
237 |
$10K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
217 |
217 |
$10K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
245 |
128 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
186 |
186 |
$2K |
| 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 |
73 |
37 |
$1K |
| 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 |
77 |
39 |
$1K |