| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
9,124 |
4,673 |
$464K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
936 |
520 |
$416K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
4,403 |
2,318 |
$269K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
466 |
259 |
$200K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
304 |
183 |
$160K |
| L2280 |
Addition to lower extremity, molded inner boot |
548 |
254 |
$154K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
2,289 |
1,265 |
$142K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,249 |
1,080 |
$120K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
754 |
361 |
$100K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
606 |
362 |
$68K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,315 |
1,041 |
$45K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
711 |
308 |
$30K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
819 |
625 |
$27K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
49 |
36 |
$20K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
60 |
26 |
$11K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
105 |
49 |
$8K |
| 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 |
120 |
66 |
$7K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
37 |
26 |
$5K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
57 |
51 |
$4K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
17 |
12 |
$1K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
16 |
12 |
$692.50 |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
19 |
14 |
$270.06 |
| L3999 |
Upper limb orthosis, not otherwise specified |
13 |
12 |
$15.34 |