| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
2,317 |
2,305 |
$3.57M |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
1,851 |
1,281 |
$926K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
1,670 |
1,120 |
$776K |
| L2280 |
Addition to lower extremity, molded inner boot |
1,844 |
1,159 |
$769K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
1,464 |
897 |
$607K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
3,316 |
1,839 |
$188K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
564 |
517 |
$179K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,679 |
1,150 |
$91K |
| L5637 |
Addition to lower extremity, below knee, total contact |
462 |
423 |
$58K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,553 |
1,494 |
$55K |
| L5620 |
Addition to lower extremity, test socket, below knee |
417 |
380 |
$52K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
330 |
301 |
$48K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
352 |
322 |
$36K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
869 |
615 |
$32K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
46 |
40 |
$32K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
652 |
588 |
$27K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
166 |
118 |
$25K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
336 |
307 |
$24K |
| L5981 |
All lower extremity prostheses, flex-walk system or equal |
14 |
13 |
$22K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
30 |
28 |
$20K |
| L5301 |
Below knee, molded socket, shin, sach foot, endoskeletal system |
17 |
16 |
$16K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
95 |
95 |
$16K |
| L5679 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism |
35 |
31 |
$9K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
201 |
183 |
$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 |
192 |
108 |
$8K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
21 |
14 |
$7K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
471 |
427 |
$6K |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
83 |
54 |
$5K |
| L3649 |
Orthopedic shoe, modification, addition or transfer, not otherwise specified |
142 |
84 |
$4K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
41 |
38 |
$4K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
14 |
14 |
$3K |
| L8440 |
Prosthetic shrinker, below knee, each |
145 |
135 |
$3K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
26 |
25 |
$2K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
23 |
13 |
$2K |
| L8400 |
Prosthetic sheath, below knee, each |
47 |
44 |
$1K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
27 |
24 |
$1K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
27 |
25 |
$1K |
| L0984 |
Protective body sock, prefabricated, off-the-shelf, each |
13 |
13 |
$721.58 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
14 |
12 |
$224.01 |