| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Plastic mod low ext pad/line |
1,163 |
723 |
$116K |
| L3010 |
Foot longitudinal arch suppo |
570 |
307 |
$57K |
| L3020 |
Foot longitud/metatarsal sup |
384 |
245 |
$42K |
| L3000 |
Ft insert ucb berkeley shell |
101 |
87 |
$28K |
| L3222 |
Mens shoes hightop depth inl |
318 |
166 |
$28K |
| L3217 |
Ladies shoes hightop depth i |
290 |
164 |
$22K |
| L3219 |
Orthopedic mens shoes oxford |
232 |
134 |
$20K |
| L3215 |
Orthopedic ftwear ladies oxf |
257 |
151 |
$19K |
| L3216 |
Orthoped ladies shoes dpth i |
236 |
154 |
$11K |
| L3221 |
Orthopedic mens shoes dpth i |
82 |
53 |
$4K |
| L3001 |
Foot insert remov molded spe |
40 |
18 |
$4K |
| L3030 |
Foot arch support remov prem |
23 |
13 |
$2K |
| L3202 |
Oxford w/ supinat/pronator c |
34 |
32 |
$1K |
| A5512 |
Multi den insert direct form |
18 |
14 |
$1K |
| A5500 |
Diab shoe for density insert |
18 |
14 |
$1K |
| S8101 |
Spacer with mask |
28 |
28 |
$784.84 |
| A7005 |
Nondisposable nebulizer set |
28 |
28 |
$457.80 |