| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
3,378 |
2,570 |
$324K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
4,386 |
3,436 |
$307K |
| L3254 |
Non-standard size or width |
7,334 |
5,792 |
$200K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
2,529 |
1,933 |
$187K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
1,456 |
1,161 |
$185K |
| L3580 |
Orthopedic shoe addition, convert instep to velcro closure |
5,931 |
4,679 |
$184K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
316 |
262 |
$27K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
252 |
249 |
$22K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
224 |
177 |
$20K |
| S0395 |
Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic |
222 |
217 |
$9K |
| 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 |
197 |
135 |
$3K |
| 99082 |
|
67 |
65 |
$1K |
| L3255 |
Non-standard size or length |
34 |
29 |
$953.60 |
| L3070 |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
30 |
27 |
$887.40 |
| L3440 |
Heel, counter, leather reinforced |
19 |
16 |
$827.32 |
| 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 |
22 |
17 |
$591.52 |