| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1200 |
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only |
12 |
12 |
$9K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
33 |
14 |
$1K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
50 |
27 |
$1K |
| L0984 |
Protective body sock, prefabricated, off-the-shelf, each |
25 |
25 |
$939.67 |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
70 |
38 |
$780.31 |
| L1290 |
Addition to tlso, (low profile), lateral trochanteric pad |
25 |
25 |
$419.04 |
| L1210 |
Addition to tlso, (low profile), lateral thoracic extension |
25 |
25 |
$401.17 |
| L1240 |
Addition to tlso, (low profile), lumbar derotation pad |
24 |
24 |
$388.00 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
19 |
12 |
$180.31 |