| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
6,328 |
6,176 |
$482K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,859 |
1,814 |
$291K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
6,250 |
6,107 |
$208K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
6,067 |
5,940 |
$183K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,153 |
1,128 |
$129K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,996 |
1,957 |
$124K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
708 |
695 |
$115K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,935 |
2,864 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
5,963 |
5,848 |
$23K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
38 |
38 |
$6K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
12 |
12 |
$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 |
43 |
31 |
$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 |
38 |
27 |
$1K |
| A4402 |
Lubricant, per ounce |
78 |
77 |
$626.79 |