| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
7,702 |
3,828 |
$18K |
| L3807 |
Whfo w/o joints pre cst |
2,155 |
1,867 |
$13K |
| A5512 |
Multi den insert direct form |
7,678 |
3,829 |
$11K |
| L3760 |
Eo adj jt prefab custom fit |
859 |
727 |
$9K |
| L1831 |
Knee orth pos locking joint |
2,496 |
1,452 |
$9K |
| L3809 |
Whfo w/o joints pre ots |
1,868 |
1,290 |
$5K |
| L4396 |
Static or dynami afo pre cst |
936 |
702 |
$5K |
| L3761 |
Eo, adj lock joint prefab ot |
270 |
184 |
$2K |
| L4397 |
Static or dynami afo pre ots |
1,011 |
432 |
$2K |
| L1833 |
Ko adj jnt pos r sup pre ots |
92 |
72 |
$2K |
| L1652 |
Ho bi thighcuffs w sprdr bar |
250 |
212 |
$1K |
| L1832 |
Ko adj jnt pos r sup pre cst |
46 |
28 |
$249.00 |
| L1932 |
Afo rig ant tib tcf/= custom |
19 |
18 |
$45.63 |