| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
12,274 |
6,135 |
$2.28M |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
8,224 |
4,712 |
$890K |
| L3410 |
Metatarsal bar wedge, between sole |
10,436 |
5,242 |
$632K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
6,191 |
3,292 |
$396K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
4,623 |
2,453 |
$346K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,033 |
1,849 |
$236K |
| L3485 |
Heel, pad, removable for spur |
7,044 |
3,536 |
$232K |
| L3370 |
Sole wedge, between sole |
6,285 |
3,160 |
$195K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
6,905 |
3,471 |
$190K |
| A7030 |
Full face mask used with positive airway pressure device, each |
798 |
791 |
$74K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
486 |
481 |
$71K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,197 |
814 |
$46K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
961 |
665 |
$44K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,055 |
1,047 |
$42K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
151 |
151 |
$35K |
| A4554 |
Disposable underpads, all sizes |
372 |
353 |
$23K |
| E0570 |
Nebulizer, with compressor |
296 |
293 |
$23K |
| A7035 |
Headgear used with positive airway pressure device |
1,068 |
1,063 |
$13K |
| L3390 |
Outflare wedge |
390 |
197 |
$12K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,203 |
1,192 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
1,066 |
1,061 |
$9K |
| E0601 |
Continuous positive airway pressure (cpap) device |
24 |
24 |
$7K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
130 |
65 |
$7K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
59 |
58 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
252 |
250 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
186 |
185 |
$3K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
106 |
105 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
28 |
26 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,045 |
1,041 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
53 |
51 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
57 |
57 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,131 |
1,124 |
$2K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
28 |
14 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
376 |
360 |
$1K |
| L3260 |
Surgical boot/shoe, each |
69 |
69 |
$1K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
12 |
12 |
$504.00 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
17 |
17 |
$233.74 |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
12 |
12 |
$126.10 |