| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
10,898 |
6,053 |
$2.12M |
| A6545 |
Grad com non-elastic bk surg |
15,713 |
8,466 |
$1.47M |
| S1040 |
Cranial remolding orthosis |
449 |
447 |
$1.14M |
| A5500 |
Diab shoe for density insert |
16,745 |
9,116 |
$688K |
| A5513 |
Multi den insert custom mold |
12,946 |
7,024 |
$528K |
| L3908 |
Who cock-up nonmolde pre ots |
10,267 |
7,191 |
$422K |
| L1833 |
Ko adj jnt pos r sup pre ots |
990 |
900 |
$398K |
| L1832 |
Ko adj jnt pos r sup pre cst |
1,304 |
1,181 |
$398K |
| L4360 |
Pneumat walking boot pre cst |
2,119 |
2,093 |
$284K |
| L3809 |
Whfo w/o joints pre ots |
1,982 |
1,589 |
$280K |
| L1970 |
Afo plastic molded w/ankle j |
725 |
551 |
$270K |
| L1820 |
Ko elas w/ condyle pads & jo |
3,785 |
3,160 |
$244K |
| L5673 |
Socket insert w lock mech |
302 |
283 |
$225K |
| L4361 |
Pneuma/vac walk boot pre ots |
1,287 |
1,258 |
$213K |
| A4595 |
Tens suppl 2 lead per month |
2,575 |
2,562 |
$195K |
| L2820 |
Soft interface below knee se |
3,277 |
2,524 |
$190K |
| L8030 |
Breast prosthes w/o adhesive |
952 |
795 |
$181K |
| L5301 |
Bk mold socket sach ft endo |
107 |
99 |
$167K |
| L2275 |
Plastic mod low ext pad/line |
2,630 |
1,955 |
$160K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
742 |
738 |
$145K |
| A5512 |
Multi den insert direct form |
3,763 |
2,125 |
$122K |
| L1906 |
Afo multilig ank sup pre ots |
1,557 |
1,404 |
$120K |
| E0730 |
Tens four lead |
701 |
699 |
$97K |
| L1810 |
Ko elastic with joints |
1,590 |
1,355 |
$94K |
| L2270 |
Varus/valgus strap padded/li |
2,224 |
1,637 |
$82K |
| L4396 |
Static or dynami afo pre cst |
887 |
673 |
$77K |
| L5671 |
Bk/ak locking mechanism |
177 |
165 |
$57K |
| L8000 |
Mastectomy bra |
1,332 |
1,107 |
$56K |
| L5940 |
Endo bk ultra-light material |
214 |
203 |
$51K |
| L2397 |
Suspension sleeve lower ext |
885 |
814 |
$45K |
| L5987 |
Shank ft w vert load pylon |
15 |
13 |
$44K |
| L5000 |
Sho insert w arch toe filler |
253 |
218 |
$42K |
| L5637 |
Below knee total contact |
201 |
190 |
$41K |
| L1960 |
Afo pos solid ank plastic mo |
127 |
104 |
$37K |
| L2755 |
Carbon graphite lamination |
697 |
637 |
$36K |
| L3670 |
So acro/clav can web pre ots |
504 |
497 |
$35K |
| L5620 |
Test socket below knee |
202 |
191 |
$31K |
| L2220 |
Dorsi & plantar flex ass/res |
400 |
298 |
$31K |
| L5962 |
Below knee flex cover system |
106 |
100 |
$30K |
| L0625 |
Lo flex l1-below l5 pre ots |
1,093 |
1,092 |
$30K |
| L0648 |
Lso sag r an/pos pnl pre ots |
55 |
54 |
$30K |
| L2390 |
Offset knee joint each |
498 |
458 |
$28K |
| L5704 |
Custom shape cover bk |
107 |
101 |
$27K |
| L0637 |
Lso sc r ant/pos pnl pre cst |
41 |
40 |
$25K |
| L5910 |
Endo below knee alignable sy |
163 |
153 |
$20K |
| L1844 |
Ko w/adj jt rot cntrl molded |
26 |
22 |
$20K |
| L5629 |
Below knee acrylic socket |
214 |
203 |
$19K |
| L8420 |
Prosthetic sock multi ply bk |
306 |
293 |
$17K |
| L3808 |
Whfo, rigid w/o joints |
101 |
79 |
$15K |
| E0114 |
Crutch underarm pair no wood |
492 |
490 |
$14K |
| L4386 |
Non-pneum walk boot pre cst |
184 |
181 |
$14K |
| L3260 |
Ambulatory surgical boot eac |
220 |
211 |
$13K |
| L5986 |
Multi-axial rotation unit |
42 |
41 |
$12K |
| L5685 |
Below knee sus/seal sleeve |
97 |
91 |
$11K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
15 |
15 |
$11K |
| L0621 |
Sio flex pelvic/sacr pre ots |
167 |
166 |
$11K |
| L8400 |
Sheath below knee |
188 |
179 |
$10K |
| L1846 |
Ko w adj flex/ext rotat mold |
16 |
15 |
$9K |
| L5668 |
Bk molded distal cushion |
88 |
83 |
$8K |
| L8470 |
Pros sock single ply bk |
298 |
284 |
$6K |
| L0631 |
Lso sag r an/pos pnl pre cst |
12 |
12 |
$6K |
| L8440 |
Shrinker below knee |
141 |
132 |
$5K |
| L3710 |
Eo elas w/metal jnts pre ots |
80 |
64 |
$4K |
| L2795 |
Knee control full kneecap |
84 |
75 |
$4K |
| L1843 |
Ko single upright pre cst |
16 |
15 |
$4K |
| L8417 |
Pros sheath/sock w gel cushn |
12 |
12 |
$3K |
| L1812 |
Ko elastic w/joints pre ots |
31 |
27 |
$2K |
| L5972 |
Flexible keel foot |
13 |
13 |
$2K |
| L3221 |
Orthopedic mens shoes dpth i |
28 |
14 |
$2K |
| L0628 |
Lso flex no ri stays pre ots |
55 |
54 |
$2K |
| L2830 |
Soft interface above knee se |
29 |
27 |
$2K |
| L3310 |
Shoe lift elev heel/sole neo |
31 |
26 |
$1K |
| L3762 |
Eo rigid w/o joints pre ots |
16 |
13 |
$831.15 |
| L1830 |
Ko immob canvas long pre ots |
13 |
12 |
$807.29 |
| E0100 |
Cane adjust/fixed with tip |
49 |
49 |
$555.22 |
| L3650 |
So 8 abd restraint pre ots |
12 |
12 |
$406.06 |