| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
495 |
236 |
$71K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
320 |
153 |
$37K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
89 |
43 |
$10K |