| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
11,315 |
5,641 |
$750K |
| L3216 |
Orthoped ladies shoes dpth i |
3,859 |
1,932 |
$170K |
| L3221 |
Orthopedic mens shoes dpth i |
2,567 |
1,279 |
$133K |
| L3215 |
Orthopedic ftwear ladies oxf |
1,764 |
888 |
$130K |
| L3219 |
Orthopedic mens shoes oxford |
1,171 |
586 |
$101K |
| L3050 |
Foot arch supp premold metat |
914 |
473 |
$33K |
| L3000 |
Ft insert ucb berkeley shell |
88 |
65 |
$22K |
| A5500 |
Diab shoe for density insert |
525 |
290 |
$15K |
| L3020 |
Foot longitud/metatarsal sup |
91 |
56 |
$13K |
| L3217 |
Ladies shoes hightop depth i |
162 |
81 |
$11K |
| L3040 |
Ft arch suprt premold longit |
266 |
132 |
$10K |
| A5512 |
Multi den insert direct form |
522 |
284 |
$10K |
| L2275 |
Plastic mod low ext pad/line |
95 |
52 |
$6K |
| L3222 |
Mens shoes hightop depth inl |
49 |
24 |
$4K |
| L3002 |
Foot insert plastazote or eq |
26 |
14 |
$3K |
| L3070 |
Arch suprt att to sho longit |
28 |
13 |
$729.04 |