| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
559 |
510 |
$112K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
106 |
87 |
$37K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
681 |
566 |
$13K |
| L0172 |
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
404 |
323 |
$8K |
| L3906 |
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
66 |
64 |
$7K |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
19 |
12 |
$5K |
| L3913 |
Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
75 |
72 |
$5K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
104 |
88 |
$4K |
| L3260 |
Surgical boot/shoe, each |
184 |
143 |
$3K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
17 |
14 |
$1K |
| L3933 |
Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment |
13 |
12 |
$1K |
| A4565 |
Slings |
16 |
12 |
$86.97 |
| A4620 |
Variable concentration mask |
13 |
12 |
$8.40 |
| 90837 |
Psychotherapy, 53 minutes with patient |
61 |
44 |
$0.00 |