| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Plastic mod low ext pad/line |
1,188 |
700 |
$67K |
| L2820 |
Soft interface below knee se |
620 |
393 |
$35K |
| L5620 |
Test socket below knee |
12 |
12 |
$12K |
| L2280 |
Molded inner boot |
48 |
27 |
$10K |
| A5500 |
Diab shoe for density insert |
190 |
96 |
$8K |
| L3984 |
Upper ext fx orthosis wrist |
64 |
39 |
$4K |
| L0643 |
Lso sag ctr rigi pos pre ots |
28 |
27 |
$3K |
| L5940 |
Endo bk ultra-light material |
13 |
13 |
$2K |
| L5910 |
Endo below knee alignable sy |
13 |
13 |
$1K |
| L5637 |
Below knee total contact |
12 |
12 |
$850.97 |
| L5629 |
Below knee acrylic socket |
12 |
12 |
$781.13 |
| L3908 |
Who cock-up nonmolde pre ots |
21 |
12 |
$714.42 |
| A5512 |
Multi den insert direct form |
23 |
12 |
$576.62 |