| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis |
2,317 |
2,305 |
$3.57M |
| L1970 |
Afo plastic molded w/ankle j |
1,851 |
1,281 |
$926K |
| L1960 |
Afo pos solid ank plastic mo |
1,670 |
1,120 |
$776K |
| L2280 |
Molded inner boot |
1,844 |
1,159 |
$769K |
| L1907 |
Afo supramalleolar custom |
1,464 |
897 |
$607K |
| E1028 |
W/c manual swingaway |
3,316 |
1,839 |
$188K |
| L5673 |
Socket insert w lock mech |
564 |
517 |
$179K |
| L2820 |
Soft interface below knee se |
1,679 |
1,150 |
$91K |
| L5637 |
Below knee total contact |
462 |
423 |
$58K |
| E0955 |
Cushioned headrest |
1,553 |
1,494 |
$55K |
| L5620 |
Test socket below knee |
417 |
380 |
$52K |
| L5671 |
Bk/ak locking mechanism |
330 |
301 |
$48K |
| L5629 |
Below knee acrylic socket |
352 |
322 |
$36K |
| L2200 |
Limited ankle motion ea jnt |
869 |
615 |
$32K |
| E2617 |
Custom fab w/c back cushion |
46 |
40 |
$32K |
| L8420 |
Prosthetic sock multi ply bk |
652 |
588 |
$27K |
| E0956 |
W/c lateral trunk/hip suppor |
166 |
118 |
$25K |
| L5940 |
Endo bk ultra-light material |
336 |
307 |
$24K |
| L5981 |
Flex-walk sys low ext prosth |
14 |
13 |
$22K |
| E2609 |
Custom fabricate w/c cushion |
30 |
28 |
$20K |
| L5301 |
Bk mold socket sach ft endo |
17 |
16 |
$16K |
| L4361 |
Pneuma/vac walk boot pre ots |
95 |
95 |
$16K |
| L5679 |
Socket insert w/o lock mech |
35 |
31 |
$9K |
| L5910 |
Endo below knee alignable sy |
201 |
183 |
$9K |
| A5500 |
Diab shoe for density insert |
192 |
108 |
$8K |
| L1940 |
Afo molded to patient plasti |
21 |
14 |
$7K |
| L8470 |
Pros sock single ply bk |
471 |
427 |
$6K |
| L2210 |
Dorsiflexion assist each joi |
83 |
54 |
$5K |
| L3649 |
Orthopedic shoe modifica nos |
142 |
84 |
$4K |
| L5685 |
Below knee sus/seal sleeve |
41 |
38 |
$4K |
| L3984 |
Upper ext fx orthosis wrist |
14 |
14 |
$3K |
| L8440 |
Shrinker below knee |
145 |
135 |
$3K |
| L4387 |
Non-pneum walk boot pre ots |
26 |
25 |
$2K |
| A5513 |
Multi den insert custom mold |
23 |
13 |
$2K |
| L8400 |
Sheath below knee |
47 |
44 |
$1K |
| E0960 |
W/c shoulder harness/straps |
27 |
24 |
$1K |
| L3908 |
Who cock-up nonmolde pre ots |
27 |
25 |
$1K |
| L0984 |
Protect body sock ea pre ots |
13 |
13 |
$721.58 |
| E0951 |
Loop heel |
14 |
12 |
$224.01 |