| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
8,763 |
6,965 |
$801K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
21,565 |
21,536 |
$633K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,521 |
8,504 |
$518K |
| A4554 |
Disposable underpads, all sizes |
18,050 |
18,029 |
$467K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
5,838 |
4,671 |
$356K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,493 |
3,490 |
$227K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
2,935 |
2,295 |
$207K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
6,139 |
6,116 |
$171K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,866 |
1,866 |
$79K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,673 |
2,670 |
$76K |
| 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 |
2,392 |
1,449 |
$55K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
343 |
343 |
$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 |
1,992 |
1,253 |
$40K |
| A4927 |
Gloves, non-sterile, per 100 |
2,219 |
2,212 |
$8K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
441 |
440 |
$6K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
79 |
58 |
$2K |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$500.00 |