| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
624 |
617 |
$23K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
42 |
41 |
$18K |
| 11721 |
|
332 |
332 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
68 |
68 |
$5K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
12 |
12 |
$1K |
| 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 |
12 |
12 |
$1K |
| 73630 |
|
12 |
12 |
$575.52 |