| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
2,808 |
2,628 |
$947K |
| A5500 |
Diab shoe for density insert |
4,549 |
3,921 |
$391K |
| A5512 |
Multi den insert direct form |
2,072 |
1,807 |
$115K |
| A6545 |
Grad com non-elastic bk surg |
695 |
578 |
$87K |
| A5513 |
Multi den insert custom mold |
2,004 |
1,749 |
$81K |
| L2820 |
Soft interface below knee se |
726 |
686 |
$48K |
| L3908 |
Who cock-up nonmolde pre ots |
757 |
715 |
$45K |
| L1820 |
Ko elas w/ condyle pads & jo |
383 |
349 |
$37K |
| L2275 |
Plastic mod low ext pad/line |
203 |
192 |
$15K |
| L4360 |
Pneumat walking boot pre cst |
70 |
70 |
$10K |
| L5000 |
Sho insert w arch toe filler |
38 |
38 |
$8K |
| L0637 |
Lso sc r ant/pos pnl pre cst |
12 |
12 |
$8K |
| L4361 |
Pneuma/vac walk boot pre ots |
38 |
38 |
$7K |
| L1832 |
Ko adj jnt pos r sup pre cst |
14 |
14 |
$5K |
| L2397 |
Suspension sleeve lower ext |
58 |
51 |
$4K |
| L1906 |
Afo multilig ank sup pre ots |
37 |
36 |
$3K |
| L2755 |
Carbon graphite lamination |
31 |
28 |
$2K |
| L2385 |
Straight knee joint heavy du |
13 |
12 |
$2K |
| L4396 |
Static or dynami afo pre cst |
19 |
13 |
$2K |
| L8000 |
Mastectomy bra |
14 |
14 |
$644.56 |