| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
242 |
183 |
$53K |
| 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 |
942 |
642 |
$32K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
64 |
43 |
$16K |
| 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 |
269 |
195 |
$9K |
| 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 |
125 |
107 |
$8K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
26 |
15 |
$3K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
22 |
13 |
$918.06 |