| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Ther cgm supply allowance |
511 |
498 |
$43K |
| L1843 |
Ko single upright pre cst |
80 |
40 |
$11K |
| L3960 |
Sewho airplan desig abdu pos |
90 |
90 |
$11K |
| L2387 |
Add le poly knee custom kafo |
213 |
108 |
$8K |
| L1851 |
Ko single upright prefab ots |
54 |
27 |
$4K |
| L1971 |
Afo w/ankle joint, prefab |
54 |
28 |
$3K |
| L0637 |
Lso sc r ant/pos pnl pre cst |
14 |
14 |
$1K |
| L0180 |
Cer post col occ/man sup adj |
27 |
27 |
$1K |
| A5500 |
Diab shoe for density insert |
122 |
62 |
$686.08 |
| A5512 |
Multi den insert direct form |
118 |
61 |
$35.84 |
| L3916 |
Who nontorsion jnts pre ots |
24 |
12 |
$0.00 |