| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
867 |
715 |
$364K |
| L1960 |
Afo pos solid ank plastic mo |
411 |
342 |
$249K |
| L2275 |
Plastic mod low ext pad/line |
1,393 |
1,158 |
$211K |
| T4522 |
Adult size brief/diaper med |
1,745 |
1,224 |
$170K |
| L2840 |
Tibial length sock fx or equ |
1,516 |
1,276 |
$143K |
| T4523 |
Adult size brief/diaper lg |
1,236 |
910 |
$130K |
| S1040 |
Cranial remolding orthosis |
68 |
62 |
$112K |
| E1028 |
W/c manual swingaway |
2,924 |
1,660 |
$111K |
| L2280 |
Molded inner boot |
238 |
183 |
$103K |
| E1161 |
Manual adult wc w tiltinspac |
340 |
329 |
$91K |
| T4527 |
Adult size pull-on lg |
1,341 |
1,049 |
$81K |
| L2820 |
Soft interface below knee se |
712 |
593 |
$80K |
| L2270 |
Varus/valgus strap padded/li |
887 |
728 |
$57K |
| K0108 |
W/c component-accessory nos |
369 |
226 |
$37K |
| E0955 |
Cushioned headrest |
1,070 |
1,003 |
$31K |
| K0739 |
Repair/svc dme non-oxygen eq |
613 |
543 |
$21K |
| L1970 |
Afo plastic molded w/ankle j |
19 |
15 |
$13K |
| T4528 |
Adult size pull-on xl |
168 |
137 |
$13K |
| T4526 |
Adult size pull-on med |
182 |
138 |
$11K |
| E1002 |
Pwr seat tilt |
13 |
12 |
$11K |
| L3202 |
Oxford w/ supinat/pronator c |
84 |
69 |
$8K |
| K0040 |
Adjustable angle footplate |
54 |
38 |
$3K |
| T4543 |
Adult disp brief/diap abv xl |
14 |
12 |
$2K |
| T4535 |
Disposable liner/shield/pad |
37 |
26 |
$2K |
| E0973 |
W/ch access det adj armrest |
15 |
12 |
$1K |
| K0004 |
High strength ltwt whlchr |
99 |
99 |
$1K |
| L2200 |
Limited ankle motion ea jnt |
15 |
12 |
$687.91 |
| E0978 |
W/c acc,saf belt pelv strap |
28 |
27 |
$641.92 |
| E0971 |
Wheelchair anti-tipping devi |
17 |
13 |
$567.12 |
| E2213 |
Pneumatic prop tire insert |
14 |
12 |
$540.80 |