| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
867 |
538 |
$288K |
| 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 |
1,665 |
1,086 |
$105K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,145 |
693 |
$84K |
| 99213 |
|
1,128 |
1,083 |
$79K |
| 99212 |
|
1,574 |
1,463 |
$70K |
| 99203 |
|
654 |
651 |
$58K |
| 99202 |
|
541 |
537 |
$31K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
974 |
618 |
$29K |
| L4397 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
220 |
164 |
$28K |
| 11721 |
|
622 |
619 |
$11K |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
126 |
63 |
$11K |
| L3100 |
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf |
333 |
176 |
$11K |
| 29540 |
|
27 |
27 |
$427.91 |
| 20550 |
|
14 |
12 |
$377.05 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
47 |
44 |
$37.64 |