| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Pneumat walking boot pre cst |
2,904 |
2,400 |
$481K |
| L3807 |
Whfo w/o joints pre cst |
837 |
709 |
$126K |
| L1820 |
Ko elas w/ condyle pads & jo |
1,507 |
1,208 |
$107K |
| L3908 |
Who cock-up nonmolde pre ots |
2,516 |
2,079 |
$89K |
| L1902 |
Afo ankle gauntlet pre ots |
1,257 |
1,053 |
$61K |
| A4554 |
Disposable underpads |
197 |
154 |
$9K |
| T4528 |
Adult size pull-on xl |
51 |
33 |
$5K |
| T4527 |
Adult size pull-on lg |
32 |
24 |
$4K |
| L4386 |
Non-pneum walk boot pre cst |
47 |
25 |
$3K |
| E2386 |
Foam filled drive wheel tire |
13 |
13 |
$795.81 |
| E0112 |
Crutch underarm pair wood |
30 |
28 |
$737.44 |
| E2387 |
Foam filled caster tire |
13 |
13 |
$614.09 |
| K0739 |
Repair/svc dme non-oxygen eq |
12 |
12 |
$0.00 |
| L2232 |
Rocker bottom, contact afo |
14 |
14 |
$0.00 |