| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5679 |
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, not for use with locking mechanism |
168 |
125 |
$61K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
99 |
83 |
$9K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
28 |
25 |
$1K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
27 |
24 |
$347.02 |