| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
5,168 |
2,964 |
$346K |
| A5513 |
Multi den insert custom mold |
2,612 |
1,472 |
$107K |
| L3030 |
Foot arch support remov prem |
1,535 |
786 |
$105K |
| L3215 |
Orthopedic ftwear ladies oxf |
1,236 |
665 |
$100K |
| L3000 |
Ft insert ucb berkeley shell |
248 |
173 |
$89K |
| L3020 |
Foot longitud/metatarsal sup |
721 |
440 |
$83K |
| A5512 |
Multi den insert direct form |
1,633 |
1,009 |
$54K |
| L3219 |
Orthopedic mens shoes oxford |
362 |
192 |
$34K |
| L3216 |
Orthoped ladies shoes dpth i |
479 |
299 |
$28K |
| A5514 |
Mult den insert dir carv/cam |
99 |
49 |
$4K |
| L3221 |
Orthopedic mens shoes dpth i |
48 |
29 |
$3K |