| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0650 |
Lso sc r ant/pos pnl pre ots |
74 |
72 |
$8K |
| L3960 |
Sewho airplan desig abdu pos |
143 |
131 |
$6K |
| L1851 |
Ko single upright prefab ots |
126 |
71 |
$4K |
| L1833 |
Ko adj jnt pos r sup pre ots |
212 |
128 |
$4K |
| L0457 |
Tlso flex trnk sj-ss pre ots |
75 |
73 |
$3K |
| L1971 |
Afo w/ankle joint, prefab |
126 |
80 |
$2K |
| L2397 |
Suspension sleeve lower ext |
348 |
234 |
$1K |
| L1690 |
Combination bilateral ho |
56 |
56 |
$967.26 |
| L2624 |
Hip adj flex ext abduct cont |
69 |
49 |
$717.09 |
| L3170 |
Foot plas heel stabi pre ots |
130 |
83 |
$204.60 |
| L1906 |
Afo multilig ank sup pre ots |
24 |
14 |
$113.51 |
| L3916 |
Who nontorsion jnts pre ots |
18 |
16 |
$0.00 |