| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
2,025 |
1,314 |
$188K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,781 |
1,147 |
$108K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,052 |
650 |
$64K |
| L3254 |
Non-standard size or width |
1,358 |
1,254 |
$23K |
| 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 |
833 |
388 |
$18K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
119 |
103 |
$9K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
239 |
146 |
$9K |
| L3255 |
Non-standard size or length |
95 |
90 |
$2K |
| L3320 |
Lift, elevation, heel and sole, cork, per inch |
14 |
12 |
$1K |
| L2999 |
Lower extremity orthoses, not otherwise specified |
20 |
15 |
$527.00 |
| 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 |
34 |
13 |
$267.39 |