| Code | Description | Total Paid |
|---|
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
$764K |
| E0575 |
Nebulizer, ultrasonic, large volume |
$601K |
| A4554 |
Disposable underpads, all sizes |
$361K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
$346K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
$308K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
$190K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
$181K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
$180K |
| 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 |
$167K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
$140K |