| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
3,114 |
1,580 |
$682K |
| A5500 |
Diab shoe for density insert |
6,142 |
3,151 |
$239K |
| L2820 |
Soft interface below knee se |
2,513 |
1,705 |
$154K |
| L2275 |
Plastic mod low ext pad/line |
2,154 |
1,372 |
$132K |
| L1820 |
Ko elas w/ condyle pads & jo |
1,686 |
1,466 |
$123K |
| A5513 |
Multi den insert custom mold |
4,153 |
2,237 |
$107K |
| L4360 |
Pneumat walking boot pre cst |
655 |
652 |
$106K |
| L1960 |
Afo pos solid ank plastic mo |
371 |
234 |
$105K |
| L3908 |
Who cock-up nonmolde pre ots |
2,377 |
1,900 |
$103K |
| L1970 |
Afo plastic molded w/ankle j |
271 |
204 |
$99K |
| L2270 |
Varus/valgus strap padded/li |
1,970 |
1,214 |
$76K |
| L5673 |
Socket insert w lock mech |
173 |
137 |
$74K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
278 |
276 |
$65K |
| L2112 |
Afo tibial fracture soft |
204 |
202 |
$47K |
| A6549 |
Grad com garm noc day use |
168 |
96 |
$44K |
| L1832 |
Ko adj jnt pos r sup pre cst |
97 |
96 |
$37K |
| L3809 |
Whfo w/o joints pre ots |
236 |
202 |
$36K |
| A5512 |
Multi den insert direct form |
1,165 |
564 |
$27K |
| L4386 |
Non-pneum walk boot pre cst |
256 |
251 |
$25K |
| L1906 |
Afo multilig ank sup pre ots |
219 |
202 |
$20K |
| L8000 |
Mastectomy bra |
256 |
254 |
$13K |
| L8030 |
Breast prosthes w/o adhesive |
67 |
57 |
$12K |
| L8420 |
Prosthetic sock multi ply bk |
341 |
279 |
$11K |
| L8400 |
Sheath below knee |
284 |
232 |
$10K |
| L2220 |
Dorsi & plantar flex ass/res |
127 |
87 |
$10K |
| L0174 |
Cerv sr 2pc thor ext pre ots |
42 |
42 |
$8K |
| L2830 |
Soft interface above knee se |
117 |
106 |
$8K |
| L8440 |
Shrinker below knee |
229 |
184 |
$6K |
| L8470 |
Pros sock single ply bk |
363 |
298 |
$6K |
| L3650 |
So 8 abd restraint pre ots |
157 |
155 |
$5K |
| L2397 |
Suspension sleeve lower ext |
53 |
49 |
$4K |
| L4396 |
Static or dynami afo pre cst |
30 |
26 |
$3K |
| A6545 |
Grad com non-elastic bk surg |
23 |
13 |
$3K |
| L2795 |
Knee control full kneecap |
43 |
39 |
$2K |
| L5685 |
Below knee sus/seal sleeve |
41 |
37 |
$2K |
| L1120 |
Covers for upright each |
65 |
65 |
$2K |
| L5620 |
Test socket below knee |
18 |
16 |
$1K |