| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Pneuma/vac walk boot pre ots |
307 |
257 |
$42K |
| L2840 |
Tibial length sock fx or equ |
49 |
24 |
$5K |
| L2275 |
Plastic mod low ext pad/line |
51 |
26 |
$4K |
| L3908 |
Who cock-up nonmolde pre ots |
129 |
111 |
$4K |
| L1902 |
Afo ankle gauntlet pre ots |
125 |
84 |
$4K |
| A5500 |
Diab shoe for density insert |
324 |
130 |
$3K |
| L2270 |
Varus/valgus strap padded/li |
86 |
44 |
$3K |
| L2820 |
Soft interface below knee se |
55 |
27 |
$2K |
| A5513 |
Multi den insert custom mold |
99 |
31 |
$1K |
| K0903 |
Mult den insert dir carv/cam |
50 |
27 |
$265.70 |