| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
2,904 |
2,400 |
$481K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
837 |
709 |
$126K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,507 |
1,208 |
$107K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,516 |
2,079 |
$89K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,257 |
1,053 |
$61K |
| A4554 |
Disposable underpads, all sizes |
197 |
154 |
$9K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
51 |
33 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
32 |
24 |
$4K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
47 |
25 |
$3K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
13 |
13 |
$795.81 |
| E0112 |
Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips |
30 |
28 |
$737.44 |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
13 |
13 |
$614.09 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$0.00 |
| L2232 |
Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only |
14 |
14 |
$0.00 |