| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
202 |
132 |
$22K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
73 |
49 |
$2K |
| 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 |
64 |
48 |
$344.19 |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
15 |
13 |
$75.66 |
| L8440 |
Prosthetic shrinker, below knee, each |
14 |
12 |
$58.20 |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
33 |
24 |
$36.60 |