| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,106 |
968 |
$897K |
| L3010 |
Foot longitudinal arch suppo |
2,513 |
1,268 |
$276K |
| L3649 |
Orthopedic shoe modifica nos |
1,483 |
693 |
$254K |
| L1960 |
Afo pos solid ank plastic mo |
743 |
460 |
$249K |
| L1970 |
Afo plastic molded w/ankle j |
613 |
398 |
$228K |
| L2280 |
Molded inner boot |
788 |
422 |
$208K |
| L2275 |
Plastic mod low ext pad/line |
2,177 |
1,206 |
$162K |
| S1040 |
Cranial remolding orthosis |
92 |
90 |
$158K |
| L5673 |
Socket insert w lock mech |
406 |
334 |
$155K |
| L1907 |
Afo supramalleolar custom |
265 |
141 |
$93K |
| L2270 |
Varus/valgus strap padded/li |
1,835 |
1,153 |
$44K |
| L2820 |
Soft interface below knee se |
908 |
625 |
$37K |
| L5620 |
Test socket below knee |
250 |
211 |
$30K |
| L5671 |
Bk/ak locking mechanism |
169 |
154 |
$25K |
| L5910 |
Endo below knee alignable sy |
206 |
175 |
$24K |
| L5645 |
Bk flex inner socket ext fra |
100 |
89 |
$22K |
| L5637 |
Below knee total contact |
247 |
208 |
$21K |
| L8420 |
Prosthetic sock multi ply bk |
422 |
360 |
$12K |
| A5500 |
Diab shoe for density insert |
316 |
160 |
$9K |
| L2200 |
Limited ankle motion ea jnt |
227 |
160 |
$6K |
| L8470 |
Pros sock single ply bk |
418 |
357 |
$4K |
| L5679 |
Socket insert w/o lock mech |
12 |
12 |
$3K |
| L2220 |
Dorsi & plantar flex ass/res |
49 |
37 |
$2K |
| L5629 |
Below knee acrylic socket |
12 |
12 |
$2K |
| L8440 |
Shrinker below knee |
79 |
65 |
$2K |
| A5513 |
Multi den insert custom mold |
49 |
27 |
$1K |
| L2210 |
Dorsiflexion assist each joi |
16 |
14 |
$522.84 |