| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Plastic mod low ext pad/line |
1,663 |
850 |
$102K |
| L1970 |
Afo plastic molded w/ankle j |
102 |
52 |
$24K |
| L1907 |
Afo supramalleolar custom |
56 |
25 |
$10K |
| L1960 |
Afo pos solid ank plastic mo |
28 |
12 |
$6K |
| L2840 |
Tibial length sock fx or equ |
111 |
55 |
$5K |
| A5500 |
Diab shoe for density insert |
87 |
65 |
$3K |
| L3010 |
Foot longitudinal arch suppo |
31 |
15 |
$3K |
| L2820 |
Soft interface below knee se |
24 |
12 |
$2K |
| L2200 |
Limited ankle motion ea jnt |
23 |
12 |
$718.83 |
| A5513 |
Multi den insert custom mold |
19 |
16 |
$509.36 |