| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Plastic mod low ext pad/line |
1,410 |
953 |
$143K |
| A5513 |
Multi den insert custom mold |
1,534 |
917 |
$98K |
| A5500 |
Diab shoe for density insert |
2,346 |
1,326 |
$84K |
| L2820 |
Soft interface below knee se |
1,390 |
997 |
$70K |
| L5673 |
Socket insert w lock mech |
62 |
52 |
$33K |
| L1907 |
Afo supramalleolar custom |
30 |
26 |
$19K |
| L1960 |
Afo pos solid ank plastic mo |
19 |
12 |
$6K |
| L5940 |
Endo bk ultra-light material |
13 |
12 |
$3K |
| L5671 |
Bk/ak locking mechanism |
13 |
12 |
$3K |
| L5910 |
Endo below knee alignable sy |
13 |
12 |
$2K |
| L5637 |
Below knee total contact |
13 |
12 |
$2K |
| L8420 |
Prosthetic sock multi ply bk |
15 |
14 |
$1K |
| L8470 |
Pros sock single ply bk |
14 |
13 |
$265.47 |