| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,122 |
11,014 |
$601K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,617 |
4,587 |
$575K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
7,158 |
3,525 |
$468K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,319 |
1,318 |
$357K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,017 |
7,937 |
$344K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,609 |
2,592 |
$259K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
7,751 |
7,679 |
$232K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
2,061 |
1,030 |
$231K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
2,722 |
1,354 |
$215K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
1,366 |
681 |
$128K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,753 |
4,704 |
$127K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
2,666 |
1,318 |
$118K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,776 |
873 |
$92K |
| L3410 |
Metatarsal bar wedge, between sole |
748 |
369 |
$47K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
616 |
609 |
$44K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,319 |
2,315 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
6,956 |
6,864 |
$31K |
| L3485 |
Heel, pad, removable for spur |
683 |
336 |
$23K |
| A4335 |
Incontinence supply; miscellaneous |
2,660 |
2,656 |
$12K |
| A4670 |
Automatic blood pressure monitor |
106 |
106 |
$5K |
| A4402 |
Lubricant, per ounce |
861 |
856 |
$4K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
29 |
29 |
$2K |
| L3340 |
Heel wedge, sach |
32 |
16 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
28 |
14 |
$653.76 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
14 |
14 |
$539.42 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
29 |
29 |
$474.15 |
| E1399 |
Durable medical equipment, miscellaneous |
172 |
172 |
$468.01 |