| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
623 |
588 |
$21K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
263 |
256 |
$15K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
296 |
294 |
$9K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
87 |
86 |
$3K |
| L3265 |
Plastazote sandal, each |
13 |
13 |
$442.00 |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
14 |
12 |
$119.60 |