| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3202 |
Oxford w/ supinat/pronator c |
9,124 |
4,673 |
$464K |
| L1907 |
Afo supramalleolar custom |
936 |
520 |
$416K |
| L3060 |
Foot arch supp longitud/meta |
4,403 |
2,318 |
$269K |
| L1960 |
Afo pos solid ank plastic mo |
466 |
259 |
$200K |
| L1970 |
Afo plastic molded w/ankle j |
304 |
183 |
$160K |
| L2280 |
Molded inner boot |
548 |
254 |
$154K |
| L2820 |
Soft interface below knee se |
2,289 |
1,265 |
$142K |
| L4386 |
Non-pneum walk boot pre cst |
1,249 |
1,080 |
$120K |
| L3010 |
Foot longitudinal arch suppo |
754 |
361 |
$100K |
| L2275 |
Plastic mod low ext pad/line |
606 |
362 |
$68K |
| E0114 |
Crutch underarm pair no wood |
1,315 |
1,041 |
$45K |
| L3206 |
Hightop w/ supp/pronator chi |
711 |
308 |
$30K |
| L3908 |
Who cock-up nonmolde pre ots |
819 |
625 |
$27K |
| L1940 |
Afo molded to patient plasti |
49 |
36 |
$20K |
| L1930 |
Afo plastic |
60 |
26 |
$11K |
| L3221 |
Orthopedic mens shoes dpth i |
105 |
49 |
$8K |
| A5500 |
Diab shoe for density insert |
120 |
66 |
$7K |
| L3807 |
Whfo w/o joints pre cst |
37 |
26 |
$5K |
| L1810 |
Ko elastic with joints |
57 |
51 |
$4K |
| L8420 |
Prosthetic sock multi ply bk |
17 |
12 |
$1K |
| L8000 |
Mastectomy bra |
16 |
12 |
$692.50 |
| L8470 |
Pros sock single ply bk |
19 |
14 |
$270.06 |
| L3999 |
Upper limb orthosis nos |
13 |
12 |
$15.34 |