| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot longitudinal arch suppo |
189 |
130 |
$42K |
| L1960 |
Afo pos solid ank plastic mo |
13 |
12 |
$14K |
| A5514 |
Mult den insert dir carv/cam |
79 |
54 |
$12K |
| L5679 |
Socket insert w/o lock mech |
15 |
13 |
$10K |
| A5500 |
Diab shoe for density insert |
85 |
58 |
$7K |
| L3216 |
Orthoped ladies shoes dpth i |
49 |
30 |
$6K |
| L3221 |
Orthopedic mens shoes dpth i |
41 |
28 |
$5K |
| L5673 |
Socket insert w lock mech |
16 |
13 |
$5K |
| L3020 |
Foot longitud/metatarsal sup |
26 |
16 |
$5K |
| L8420 |
Prosthetic sock multi ply bk |
37 |
32 |
$3K |
| L2275 |
Plastic mod low ext pad/line |
30 |
25 |
$3K |
| L8470 |
Pros sock single ply bk |
36 |
32 |
$915.92 |