| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
75 |
74 |
$29K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
12 |
12 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
170 |
164 |
$15K |
| 17110 |
|
200 |
166 |
$14K |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
12 |
12 |
$10K |
| 11043 |
|
37 |
12 |
$6K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
44 |
28 |
$5K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
40 |
26 |
$4K |
| 17111 |
|
35 |
26 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
28 |
28 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
43 |
$3K |
| 11755 |
|
12 |
12 |
$859.00 |