| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
1,826 |
1,534 |
$660K |
| A5513 |
Multi den insert custom mold |
1,947 |
1,627 |
$166K |
| L1970 |
Afo plastic molded w/ankle j |
301 |
272 |
$158K |
| A5500 |
Diab shoe for density insert |
2,194 |
1,790 |
$142K |
| A6545 |
Grad com non-elastic bk surg |
844 |
613 |
$138K |
| L2820 |
Soft interface below knee se |
994 |
929 |
$77K |
| L2275 |
Plastic mod low ext pad/line |
693 |
638 |
$58K |
| L3908 |
Who cock-up nonmolde pre ots |
614 |
540 |
$35K |
| L2220 |
Dorsi & plantar flex ass/res |
144 |
134 |
$9K |
| L4396 |
Static or dynami afo pre cst |
15 |
14 |
$2K |
| L1906 |
Afo multilig ank sup pre ots |
13 |
12 |
$1K |
| L1810 |
Ko elastic with joints |
12 |
12 |
$806.83 |