| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1960 |
Afo pos solid ank plastic mo |
131 |
130 |
$82K |
| L1971 |
Afo w/ankle joint, prefab |
101 |
100 |
$43K |
| L2820 |
Soft interface below knee se |
451 |
447 |
$42K |
| L2200 |
Limited ankle motion ea jnt |
576 |
570 |
$36K |
| L1930 |
Afo plastic |
135 |
135 |
$31K |
| L3010 |
Foot longitudinal arch suppo |
129 |
129 |
$28K |
| L2300 |
Abduction bar jointed adjust |
65 |
65 |
$13K |
| L2768 |
Ortho sidebar disconnect |
64 |
64 |
$11K |
| L3020 |
Foot longitud/metatarsal sup |
14 |
14 |
$3K |
| L1660 |
Ho abduction static plastic |
25 |
25 |
$3K |
| A5513 |
Multi den insert custom mold |
12 |
12 |
$1K |
| A5500 |
Diab shoe for density insert |
25 |
25 |
$931.04 |
| V5266 |
Battery for hearing device |
40 |
40 |
$160.16 |