| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
3,913 |
2,403 |
$148K |
| L3000 |
Ft insert ucb berkeley shell |
309 |
225 |
$68K |
| A5512 |
Multi den insert direct form |
3,183 |
1,884 |
$28K |
| L2340 |
Pre-tibial shell molded to p |
107 |
95 |
$14K |
| A5513 |
Multi den insert custom mold |
254 |
157 |
$7K |
| L2250 |
Foot plate molded stirrup at |
57 |
54 |
$5K |
| L2275 |
Plastic mod low ext pad/line |
138 |
124 |
$4K |
| A6530 |
Compression stocking bk18-30 |
50 |
26 |
$3K |
| L8000 |
Mastectomy bra |
154 |
122 |
$2K |
| L2840 |
Tibial length sock fx or equ |
120 |
108 |
$2K |
| L2820 |
Soft interface below knee se |
77 |
70 |
$1K |
| L2270 |
Varus/valgus strap padded/li |
58 |
55 |
$776.00 |
| L8020 |
Mastectomy form |
23 |
14 |
$217.20 |
| L2755 |
Carbon graphite lamination |
12 |
12 |
$155.00 |
| L3170 |
Foot plas heel stabi pre ots |
17 |
16 |
$31.04 |