| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
3,032 |
1,562 |
$505K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,700 |
857 |
$359K |
| 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 |
5,822 |
2,917 |
$248K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
4,102 |
2,153 |
$154K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
119 |
107 |
$71K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
253 |
221 |
$50K |
| 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 |
823 |
441 |
$26K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
507 |
322 |
$21K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
44 |
39 |
$17K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
327 |
324 |
$17K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
176 |
129 |
$12K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
134 |
69 |
$8K |
| L5620 |
Addition to lower extremity, test socket, below knee |
43 |
38 |
$5K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
75 |
38 |
$5K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
52 |
39 |
$4K |
| L5637 |
Addition to lower extremity, below knee, total contact |
25 |
24 |
$4K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
74 |
65 |
$4K |
| L8400 |
Prosthetic sheath, below knee, each |
74 |
66 |
$4K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
25 |
24 |
$3K |
| L8440 |
Prosthetic shrinker, below knee, each |
32 |
27 |
$1K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
61 |
54 |
$1K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
14 |
12 |
$768.17 |