| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot, insert, removable, formed to patient foot, each |
11,315 |
5,641 |
$750K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
3,859 |
1,932 |
$170K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
2,567 |
1,279 |
$133K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
1,764 |
888 |
$130K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
1,171 |
586 |
$101K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
914 |
473 |
$33K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
88 |
65 |
$22K |
| 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 |
525 |
290 |
$15K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
91 |
56 |
$13K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
162 |
81 |
$11K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
266 |
132 |
$10K |
| 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 |
522 |
284 |
$10K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
95 |
52 |
$6K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
49 |
24 |
$4K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
26 |
14 |
$3K |
| L3070 |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
28 |
13 |
$729.04 |