| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
2,444 |
1,245 |
$547K |
| A5500 |
Diab shoe for density insert |
3,500 |
1,778 |
$182K |
| L0633 |
Lso sc r pos/lat pnl pre cst |
389 |
388 |
$69K |
| L3908 |
Who cock-up nonmolde pre ots |
1,358 |
744 |
$62K |
| A5512 |
Multi den insert direct form |
1,592 |
798 |
$58K |
| L4396 |
Static or dynami afo pre cst |
484 |
415 |
$48K |
| A5513 |
Multi den insert custom mold |
1,274 |
667 |
$32K |
| L4361 |
Pneuma/vac walk boot pre ots |
98 |
98 |
$22K |
| L1844 |
Ko w/adj jt rot cntrl molded |
14 |
13 |
$14K |
| L1906 |
Afo multilig ank sup pre ots |
98 |
90 |
$10K |
| L4360 |
Pneumat walking boot pre cst |
44 |
44 |
$8K |
| L2820 |
Soft interface below knee se |
41 |
38 |
$3K |
| L2330 |
Lacer molded to patient mode |
12 |
12 |
$2K |
| L0172 |
Cerv col sr foam 2pc pre ots |
25 |
25 |
$2K |
| L2275 |
Plastic mod low ext pad/line |
26 |
25 |
$2K |
| L2397 |
Suspension sleeve lower ext |
18 |
17 |
$1K |