| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot longitud/metatarsal sup |
2,025 |
1,314 |
$188K |
| L3216 |
Orthoped ladies shoes dpth i |
1,781 |
1,147 |
$108K |
| L3221 |
Orthopedic mens shoes dpth i |
1,052 |
650 |
$64K |
| L3254 |
Orth foot non-stndard size/w |
1,358 |
1,254 |
$23K |
| A5500 |
Diab shoe for density insert |
833 |
388 |
$18K |
| L3202 |
Oxford w/ supinat/pronator c |
119 |
103 |
$9K |
| L3030 |
Foot arch support remov prem |
239 |
146 |
$9K |
| L3255 |
Orth foot non-standard size/ |
95 |
90 |
$2K |
| L3320 |
Shoe lift elev heel/sole cor |
14 |
12 |
$1K |
| L2999 |
Lower extremity orthosis nos |
20 |
15 |
$527.00 |
| A5513 |
Multi den insert custom mold |
34 |
13 |
$267.39 |