| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,413 |
413 |
$59K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
837 |
245 |
$36K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
447 |
354 |
$34K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,196 |
543 |
$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 |
468 |
222 |
$463.86 |
| 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 |
468 |
222 |
$379.07 |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
142 |
68 |
$250.78 |
| G0008 |
Administration of influenza virus vaccine |
84 |
84 |
$0.00 |