| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
2,961 |
1,842 |
$471K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
1,992 |
1,148 |
$111K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,933 |
1,199 |
$98K |
| 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 |
2,214 |
1,248 |
$74K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
885 |
548 |
$47K |