| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
4,862 |
2,472 |
$760K |
| A5500 |
Diab shoe for density insert |
7,064 |
3,633 |
$305K |
| A5513 |
Multi den insert custom mold |
3,411 |
1,825 |
$138K |
| L4360 |
Pneumat walking boot pre cst |
832 |
819 |
$103K |
| A5512 |
Multi den insert direct form |
2,650 |
1,301 |
$88K |
| A6549 |
Grad com garm noc day use |
469 |
305 |
$87K |
| L3908 |
Who cock-up nonmolde pre ots |
1,664 |
1,222 |
$57K |
| L2820 |
Soft interface below knee se |
764 |
536 |
$42K |
| L2275 |
Plastic mod low ext pad/line |
495 |
334 |
$34K |
| L1906 |
Afo multilig ank sup pre ots |
413 |
358 |
$29K |
| L8030 |
Breast prosthes w/o adhesive |
116 |
104 |
$22K |
| L1820 |
Ko elas w/ condyle pads & jo |
366 |
315 |
$21K |
| L8000 |
Mastectomy bra |
332 |
319 |
$18K |
| L1832 |
Ko adj jnt pos r sup pre cst |
57 |
57 |
$16K |
| L3807 |
Whfo w/o joints pre cst |
50 |
39 |
$8K |
| S1040 |
Cranial remolding orthosis |
27 |
27 |
$5K |
| L1970 |
Afo plastic molded w/ankle j |
18 |
12 |
$4K |
| L3260 |
Ambulatory surgical boot eac |
64 |
61 |
$4K |
| A9999 |
Dme supply or accessory, nos |
37 |
30 |
$3K |
| L1812 |
Ko elastic w/joints pre ots |
53 |
40 |
$2K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
13 |
12 |
$2K |
| L4396 |
Static or dynami afo pre cst |
17 |
13 |
$1K |
| A6530 |
Compression stocking bk18-30 |
33 |
30 |
$527.33 |