| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5637 |
Below knee total contact |
79 |
43 |
$60K |
| A5512 |
Multi den insert direct form |
399 |
231 |
$52K |
| L5301 |
Bk mold socket sach ft endo |
20 |
12 |
$50K |
| A5500 |
Diab shoe for density insert |
406 |
237 |
$45K |
| L5645 |
Bk flex inner socket ext fra |
79 |
43 |
$39K |
| L5673 |
Socket insert w lock mech |
40 |
23 |
$36K |
| L5629 |
Below knee acrylic socket |
79 |
43 |
$28K |
| L5620 |
Test socket below knee |
47 |
31 |
$27K |
| L5671 |
Bk/ak locking mechanism |
38 |
22 |
$26K |
| L8420 |
Prosthetic sock multi ply bk |
88 |
48 |
$26K |
| L5940 |
Endo bk ultra-light material |
33 |
18 |
$22K |
| L5910 |
Endo below knee alignable sy |
31 |
17 |
$15K |
| L5962 |
Below knee flex cover system |
26 |
15 |
$15K |
| L5704 |
Custom shape cover bk |
24 |
14 |
$11K |
| L5984 |
Endoskeletal axial rotation |
33 |
18 |
$10K |
| A6530 |
Compression stocking bk18-30 |
213 |
86 |
$9K |
| L5685 |
Below knee sus/seal sleeve |
82 |
45 |
$9K |
| L5670 |
Bk molded supracondylar susp |
20 |
12 |
$2K |
| L8470 |
Pros sock single ply bk |
88 |
48 |
$1K |