| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
3,293 |
1,689 |
$602K |
| L2116 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment |
894 |
893 |
$255K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
617 |
614 |
$142K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
2,441 |
1,246 |
$139K |
| 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 |
4,070 |
2,245 |
$127K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
1,617 |
856 |
$110K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
2,281 |
1,099 |
$108K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
954 |
507 |
$72K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
539 |
408 |
$56K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
412 |
293 |
$53K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
2,735 |
1,502 |
$51K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
175 |
174 |
$40K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
494 |
293 |
$29K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
905 |
895 |
$28K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
277 |
271 |
$28K |
| E0570 |
Nebulizer, with compressor |
385 |
385 |
$28K |
| 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 |
697 |
401 |
$23K |
| L3485 |
Heel, pad, removable for spur |
978 |
494 |
$22K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
531 |
493 |
$22K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
209 |
105 |
$22K |
| A5501 |
For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe |
68 |
34 |
$13K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
63 |
63 |
$10K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
327 |
207 |
$9K |
| L3250 |
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each |
24 |
12 |
$9K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
174 |
173 |
$8K |
| A5503 |
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe |
278 |
192 |
$6K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
251 |
250 |
$5K |
| L3260 |
Surgical boot/shoe, each |
377 |
375 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
319 |
319 |
$5K |
| A5504 |
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe |
213 |
145 |
$5K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
16 |
16 |
$4K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
142 |
89 |
$4K |
| L3224 |
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
66 |
38 |
$3K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
27 |
27 |
$3K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
23 |
12 |
$3K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
19 |
19 |
$2K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
66 |
30 |
$2K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
30 |
15 |
$2K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
31 |
16 |
$1K |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$606.00 |
| A5505 |
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe |
24 |
16 |
$561.29 |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
23 |
12 |
$469.25 |
| A4565 |
Slings |
14 |
14 |
$91.42 |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
19 |
19 |
$45.60 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
12 |
12 |
$12.77 |