| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1970 |
Afo plastic molded w/ankle j |
564 |
351 |
$161K |
| L2280 |
Molded inner boot |
668 |
350 |
$138K |
| E1399 |
Durable medical equipment mi |
390 |
337 |
$138K |
| L2275 |
Plastic mod low ext pad/line |
2,042 |
1,082 |
$112K |
| L1960 |
Afo pos solid ank plastic mo |
120 |
66 |
$35K |
| L2820 |
Soft interface below knee se |
681 |
367 |
$25K |
| L1907 |
Afo supramalleolar custom |
106 |
51 |
$19K |
| L1951 |
Afo spiral prefab custom |
13 |
12 |
$5K |
| A5500 |
Diab shoe for density insert |
134 |
68 |
$4K |
| L2200 |
Limited ankle motion ea jnt |
103 |
61 |
$2K |
| L2220 |
Dorsi & plantar flex ass/res |
31 |
26 |
$1K |
| A7003 |
Nebulizer administration set |
12 |
12 |
$20.90 |