| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
1,106 |
968 |
$897K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
2,513 |
1,268 |
$276K |
| L3649 |
Orthopedic shoe, modification, addition or transfer, not otherwise specified |
1,483 |
693 |
$254K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
743 |
460 |
$249K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
613 |
398 |
$228K |
| L2280 |
Addition to lower extremity, molded inner boot |
788 |
422 |
$208K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,177 |
1,206 |
$162K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
92 |
90 |
$158K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
406 |
334 |
$155K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
265 |
141 |
$93K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
1,835 |
1,153 |
$44K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
908 |
625 |
$37K |
| L5620 |
Addition to lower extremity, test socket, below knee |
250 |
211 |
$30K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
169 |
154 |
$25K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
206 |
175 |
$24K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
100 |
89 |
$22K |
| L5637 |
Addition to lower extremity, below knee, total contact |
247 |
208 |
$21K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
422 |
360 |
$12K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
316 |
160 |
$9K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
227 |
160 |
$6K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
418 |
357 |
$4K |
| L5679 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism |
12 |
12 |
$3K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
49 |
37 |
$2K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
12 |
12 |
$2K |
| L8440 |
Prosthetic shrinker, below knee, each |
79 |
65 |
$2K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
49 |
27 |
$1K |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
16 |
14 |
$522.84 |