| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
77 |
63 |
$6K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
98 |
73 |
$2K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
86 |
69 |
$1K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
34 |
28 |
$1K |
| 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 |
35 |
26 |
$494.16 |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
12 |
$341.20 |
| L3225 |
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
17 |
13 |
$239.22 |
| L3224 |
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
14 |
12 |
$236.90 |
| 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 |
17 |
13 |
$236.11 |