| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,405 |
1,374 |
$312K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
3,554 |
3,477 |
$249K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,762 |
3,695 |
$231K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
3,128 |
3,068 |
$120K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
637 |
624 |
$95K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,494 |
1,402 |
$80K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
269 |
266 |
$65K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
461 |
454 |
$47K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
535 |
524 |
$35K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
526 |
519 |
$35K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
540 |
523 |
$24K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
109 |
108 |
$17K |
| E0784 |
External ambulatory infusion pump, insulin |
24 |
13 |
$10K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
149 |
146 |
$10K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
28 |
28 |
$8K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
106 |
104 |
$7K |
| L0172 |
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
54 |
52 |
$5K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
28 |
28 |
$3K |
| S9999 |
Sales tax |
13 |
12 |
$0.00 |