| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
3,293 |
1,689 |
$602K |
| L2116 |
Afo tibial fracture rigid |
894 |
893 |
$255K |
| L2112 |
Afo tibial fracture soft |
617 |
614 |
$142K |
| L3215 |
Orthopedic ftwear ladies oxf |
2,441 |
1,246 |
$139K |
| A5500 |
Diab shoe for density insert |
4,070 |
2,245 |
$127K |
| L3219 |
Orthopedic mens shoes oxford |
1,617 |
856 |
$110K |
| L3030 |
Foot arch support remov prem |
2,281 |
1,099 |
$108K |
| L2275 |
Plastic mod low ext pad/line |
954 |
507 |
$72K |
| L3010 |
Foot longitudinal arch suppo |
539 |
408 |
$56K |
| L4396 |
Static or dynami afo pre cst |
412 |
293 |
$53K |
| A5512 |
Multi den insert direct form |
2,735 |
1,502 |
$51K |
| L3916 |
Who nontorsion jnts pre ots |
175 |
174 |
$40K |
| L2820 |
Soft interface below knee se |
494 |
293 |
$29K |
| L3908 |
Who cock-up nonmolde pre ots |
905 |
895 |
$28K |
| L3809 |
Whfo w/o joints pre ots |
277 |
271 |
$28K |
| E0570 |
Nebulizer with compression |
385 |
385 |
$28K |
| A5513 |
Multi den insert custom mold |
697 |
401 |
$23K |
| L3485 |
Shoe heel pad removable for |
978 |
494 |
$22K |
| L3202 |
Oxford w/ supinat/pronator c |
531 |
493 |
$22K |
| L1930 |
Afo plastic |
209 |
105 |
$22K |
| A5501 |
Diabetic custom molded shoe |
68 |
34 |
$13K |
| L2630 |
Pelvic control band & belt u |
63 |
63 |
$10K |
| A6530 |
Compression stocking bk18-30 |
327 |
207 |
$9K |
| L3250 |
Custom mold shoe remov prost |
24 |
12 |
$9K |
| L3203 |
Oxford w/ supinator/pronator |
174 |
173 |
$8K |
| A5503 |
Diabetic shoe w/roller/rockr |
278 |
192 |
$6K |
| E0114 |
Crutch underarm pair no wood |
251 |
250 |
$5K |
| L3260 |
Ambulatory surgical boot eac |
377 |
375 |
$5K |
| A7005 |
Nondisposable nebulizer set |
319 |
319 |
$5K |
| A5504 |
Diabetic shoe with wedge |
213 |
145 |
$5K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
16 |
16 |
$4K |
| L3206 |
Hightop w/ supp/pronator chi |
142 |
89 |
$4K |
| L3224 |
Woman's shoe oxford brace |
66 |
38 |
$3K |
| L3807 |
Whfo w/o joints pre cst |
27 |
27 |
$3K |
| L3002 |
Foot insert plastazote or eq |
23 |
12 |
$3K |
| E0603 |
Electric breast pump |
19 |
19 |
$2K |
| A6533 |
Gc stocking thighlngth 18-30 |
66 |
30 |
$2K |
| L3001 |
Foot insert remov molded spe |
30 |
15 |
$2K |
| L8000 |
Mastectomy bra |
31 |
16 |
$1K |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$606.00 |
| A5505 |
Diab shoe w/metatarsal bar |
24 |
16 |
$561.29 |
| L3216 |
Orthoped ladies shoes dpth i |
23 |
12 |
$469.25 |
| A4565 |
Slings |
14 |
14 |
$91.42 |
| K1005 |
Disp col sto bag breast milk |
19 |
19 |
$45.60 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$12.77 |