| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
1,263 |
672 |
$35K |
| L1971 |
Afo w/ankle joint, prefab |
325 |
184 |
$22K |
| L3216 |
Orthoped ladies shoes dpth i |
147 |
74 |
$5K |
| L3221 |
Orthopedic mens shoes dpth i |
80 |
40 |
$3K |
| L1833 |
Ko adj jnt pos r sup pre ots |
28 |
14 |
$2K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
40 |
40 |
$2K |
| L3224 |
Woman's shoe oxford brace |
100 |
68 |
$1K |
| L3225 |
Man's shoe oxford brace |
66 |
57 |
$1K |
| L1906 |
Afo multilig ank sup pre ots |
26 |
18 |
$1K |
| L1820 |
Ko elas w/ condyle pads & jo |
20 |
13 |
$390.24 |
| A5500 |
Diab shoe for density insert |
24 |
12 |
$304.40 |
| A5512 |
Multi den insert direct form |
24 |
12 |
$205.57 |