| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
4,755 |
2,768 |
$1.86M |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
3,409 |
1,809 |
$1.10M |
| L2280 |
Addition to lower extremity, molded inner boot |
3,955 |
2,105 |
$937K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
11,240 |
6,163 |
$723K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
11,428 |
6,300 |
$710K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
2,948 |
1,572 |
$249K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
5,163 |
2,818 |
$208K |
| L3906 |
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
624 |
425 |
$182K |
| L2034 |
Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated |
146 |
77 |
$158K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
475 |
266 |
$150K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
453 |
248 |
$132K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
2,434 |
1,291 |
$84K |
| L2768 |
Orthotic side bar disconnect device, per bar |
884 |
457 |
$69K |
| L2340 |
Addition to lower extremity, pre-tibial shell, molded to patient model |
203 |
106 |
$48K |
| L4205 |
Repair of orthotic device, labor component, per 15 minutes |
718 |
566 |
$45K |
| 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 |
838 |
438 |
$45K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
12 |
12 |
$28K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
153 |
101 |
$23K |
| 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 |
584 |
290 |
$19K |
| L4002 |
Replacement strap, any orthosis, includes all components, any length, any type |
682 |
414 |
$13K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
50 |
25 |
$7K |
| L2760 |
Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) |
169 |
87 |
$6K |
| L3540 |
Orthopedic shoe addition, sole, full |
13 |
13 |
$455.67 |