| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5673 |
Socket insert w lock mech |
1,054 |
948 |
$694K |
| L4361 |
Pneuma/vac walk boot pre ots |
3,163 |
3,053 |
$544K |
| A6512 |
Compres burn garment, noc |
823 |
658 |
$421K |
| L5637 |
Below knee total contact |
1,593 |
1,452 |
$290K |
| L0174 |
Cerv sr 2pc thor ext pre ots |
1,705 |
1,571 |
$264K |
| L5301 |
Bk mold socket sach ft endo |
169 |
158 |
$263K |
| L5671 |
Bk/ak locking mechanism |
830 |
741 |
$247K |
| L4360 |
Pneumat walking boot pre cst |
1,342 |
1,296 |
$228K |
| L8420 |
Prosthetic sock multi ply bk |
1,925 |
1,720 |
$206K |
| L2275 |
Plastic mod low ext pad/line |
1,486 |
1,379 |
$199K |
| L4397 |
Static or dynami afo pre ots |
1,291 |
1,203 |
$189K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
405 |
379 |
$179K |
| L2820 |
Soft interface below knee se |
2,192 |
2,033 |
$173K |
| L1960 |
Afo pos solid ank plastic mo |
259 |
243 |
$169K |
| L5940 |
Endo bk ultra-light material |
630 |
577 |
$161K |
| L3020 |
Foot longitud/metatarsal sup |
640 |
610 |
$149K |
| E0114 |
Crutch underarm pair no wood |
3,600 |
3,540 |
$147K |
| L3908 |
Who cock-up nonmolde pre ots |
3,260 |
3,176 |
$141K |
| L3807 |
Whfo w/o joints pre cst |
1,127 |
1,107 |
$138K |
| L5620 |
Test socket below knee |
705 |
640 |
$123K |
| L5910 |
Endo below knee alignable sy |
680 |
623 |
$121K |
| L1970 |
Afo plastic molded w/ankle j |
210 |
188 |
$120K |
| L5629 |
Below knee acrylic socket |
604 |
555 |
$95K |
| L8440 |
Shrinker below knee |
1,309 |
1,215 |
$88K |
| L5700 |
Replace socket below knee |
45 |
42 |
$75K |
| A5500 |
Diab shoe for density insert |
1,263 |
1,070 |
$74K |
| L1832 |
Ko adj jnt pos r sup pre cst |
216 |
205 |
$71K |
| L0464 |
Tlso 4mod sacro-scap pre |
103 |
95 |
$59K |
| L3260 |
Ambulatory surgical boot eac |
1,682 |
1,515 |
$57K |
| L1833 |
Ko adj jnt pos r sup pre ots |
151 |
146 |
$53K |
| A6533 |
Gc stocking thighlngth 18-30 |
494 |
459 |
$51K |
| A6530 |
Compression stocking bk18-30 |
532 |
482 |
$46K |
| L8400 |
Sheath below knee |
688 |
636 |
$46K |
| A5514 |
Mult den insert dir carv/cam |
1,053 |
819 |
$45K |
| L0984 |
Protect body sock ea pre ots |
603 |
574 |
$45K |
| L1902 |
Afo ankle gauntlet pre ots |
875 |
849 |
$43K |
| L1820 |
Ko elas w/ condyle pads & jo |
525 |
492 |
$43K |
| L0999 |
Add to spinal orthosis nos |
1,753 |
1,412 |
$38K |
| L3670 |
So acro/clav can web pre ots |
505 |
495 |
$35K |
| L4350 |
Ankle control ortho pre ots |
534 |
514 |
$32K |
| L1830 |
Ko immob canvas long pre ots |
550 |
512 |
$30K |
| A6509 |
Compres burn garment jacket |
30 |
27 |
$26K |
| L3030 |
Foot arch support remov prem |
487 |
438 |
$21K |
| L0460 |
Tlso 2 shl symphys-stern cst |
42 |
38 |
$20K |
| L2270 |
Varus/valgus strap padded/li |
277 |
245 |
$17K |
| L2840 |
Tibial length sock fx or equ |
350 |
320 |
$17K |
| L3010 |
Foot longitudinal arch suppo |
82 |
78 |
$17K |
| L5450 |
Postop app non-wgt bear dsg |
73 |
65 |
$14K |
| L0637 |
Lso sc r ant/pos pnl pre cst |
29 |
25 |
$14K |
| L4386 |
Non-pneum walk boot pre cst |
148 |
145 |
$13K |
| L5968 |
Multiaxial ankle w dorsiflex |
15 |
12 |
$13K |
| L2220 |
Dorsi & plantar flex ass/res |
132 |
108 |
$13K |
| L5986 |
Multi-axial rotation unit |
26 |
24 |
$12K |
| L5650 |
Tot contact ak/knee disart s |
43 |
40 |
$11K |
| L5685 |
Below knee sus/seal sleeve |
75 |
64 |
$9K |
| L5972 |
Flexible keel foot |
29 |
25 |
$8K |
| L8430 |
Prosthetic sock multi ply ak |
53 |
50 |
$7K |
| A5513 |
Multi den insert custom mold |
185 |
116 |
$7K |
| L3400 |
Shoe metatarsal bar wedge ro |
409 |
342 |
$7K |
| L1951 |
Afo spiral prefab custom |
14 |
13 |
$6K |
| L2999 |
Lower extremity orthosis nos |
147 |
133 |
$6K |
| L1812 |
Ko elastic w/joints pre ots |
89 |
86 |
$6K |
| L5690 |
Bk waist belt padded and lin |
69 |
64 |
$5K |
| L4396 |
Static or dynami afo pre cst |
28 |
26 |
$4K |
| L2200 |
Limited ankle motion ea jnt |
68 |
57 |
$3K |
| L0456 |
Tlso flex trnk sj-ss pre cst |
14 |
12 |
$3K |
| L3809 |
Whfo w/o joints pre ots |
13 |
13 |
$2K |
| L5684 |
Bk fork strap |
69 |
64 |
$2K |
| L2780 |
Non-corrosive finish |
27 |
26 |
$2K |
| L3206 |
Hightop w/ supp/pronator chi |
19 |
18 |
$1K |
| A6539 |
Gc stocking waistlngth 18-30 |
12 |
12 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
30 |
28 |
$949.95 |
| L1810 |
Ko elastic with joints |
12 |
12 |
$805.66 |
| L2830 |
Soft interface above knee se |
12 |
12 |
$772.98 |
| A5512 |
Multi den insert direct form |
13 |
13 |
$330.95 |