| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3002 |
Foot insert plastazote or eq |
3,378 |
2,570 |
$324K |
| L3216 |
Orthoped ladies shoes dpth i |
4,386 |
3,436 |
$307K |
| L3254 |
Orth foot non-stndard size/w |
7,334 |
5,792 |
$200K |
| L3221 |
Orthopedic mens shoes dpth i |
2,529 |
1,933 |
$187K |
| L3020 |
Foot longitud/metatarsal sup |
1,456 |
1,161 |
$185K |
| L3580 |
O shoe add instep velcro clo |
5,931 |
4,679 |
$184K |
| L3217 |
Ladies shoes hightop depth i |
316 |
262 |
$27K |
| L3202 |
Oxford w/ supinat/pronator c |
252 |
249 |
$22K |
| L3222 |
Mens shoes hightop depth inl |
224 |
177 |
$20K |
| S0395 |
Impression casting ft |
222 |
217 |
$9K |
| A5500 |
Diab shoe for density insert |
197 |
135 |
$3K |
| 99082 |
|
67 |
65 |
$1K |
| L3255 |
Orth foot non-standard size/ |
34 |
29 |
$953.60 |
| L3070 |
Arch suprt att to sho longit |
30 |
27 |
$887.40 |
| L3440 |
Heel leather reinforced |
19 |
16 |
$827.32 |
| A5512 |
Multi den insert direct form |
22 |
17 |
$591.52 |