| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
27 |
14 |
$536.56 |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
29 |
15 |
$112.22 |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$99.69 |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
28 |
12 |
$67.46 |