| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Pneumat walking boot pre cst |
564 |
552 |
$89K |
| L3670 |
So acro/clav can web pre ots |
684 |
674 |
$43K |
| L3908 |
Who cock-up nonmolde pre ots |
700 |
625 |
$29K |
| E0114 |
Crutch underarm pair no wood |
450 |
443 |
$10K |
| A5500 |
Diab shoe for density insert |
450 |
213 |
$9K |
| L0639 |
Lso s/c shell/panel prefab |
12 |
12 |
$6K |
| L3807 |
Whfo w/o joints pre cst |
46 |
37 |
$6K |
| L1810 |
Ko elastic with joints |
77 |
74 |
$5K |
| L3020 |
Foot longitud/metatarsal sup |
26 |
13 |
$3K |
| L4386 |
Non-pneum walk boot pre cst |
17 |
17 |
$2K |
| A5513 |
Multi den insert custom mold |
46 |
27 |
$1K |
| L1902 |
Afo ankle gauntlet pre ots |
14 |
14 |
$667.66 |
| L2820 |
Soft interface below knee se |
16 |
12 |
$581.06 |