| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
1,410 |
953 |
$143K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
1,534 |
917 |
$98K |
| 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 |
2,346 |
1,326 |
$84K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,390 |
997 |
$70K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
62 |
52 |
$33K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
30 |
26 |
$19K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
19 |
12 |
$6K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
13 |
12 |
$3K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
13 |
12 |
$3K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
13 |
12 |
$2K |
| L5637 |
Addition to lower extremity, below knee, total contact |
13 |
12 |
$2K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
15 |
14 |
$1K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
14 |
13 |
$265.47 |