| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
549 |
397 |
$120K |
| 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 |
327 |
237 |
$19K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
122 |
101 |
$19K |
| L3410 |
Metatarsal bar wedge, between sole |
108 |
70 |
$13K |
| 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 |
104 |
85 |
$5K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
39 |
38 |
$4K |