| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,181 |
743 |
$73K |
| L3209 |
Surgical boot, each, child |
722 |
442 |
$35K |
| 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 |
476 |
255 |
$23K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
32 |
29 |
$9K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
34 |
14 |
$9K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
229 |
122 |
$8K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
16 |
14 |
$3K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
29 |
24 |
$438.87 |