| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Grad com garm noc day use |
3,032 |
1,562 |
$505K |
| L3000 |
Ft insert ucb berkeley shell |
1,700 |
857 |
$359K |
| A5500 |
Diab shoe for density insert |
5,822 |
2,917 |
$248K |
| A5513 |
Multi den insert custom mold |
4,102 |
2,153 |
$154K |
| L5673 |
Socket insert w lock mech |
119 |
107 |
$71K |
| L8030 |
Breast prosthes w/o adhesive |
253 |
221 |
$50K |
| A5512 |
Multi den insert direct form |
823 |
441 |
$26K |
| L3908 |
Who cock-up nonmolde pre ots |
507 |
322 |
$21K |
| L5671 |
Bk/ak locking mechanism |
44 |
39 |
$17K |
| L8000 |
Mastectomy bra |
327 |
324 |
$17K |
| L1820 |
Ko elas w/ condyle pads & jo |
176 |
129 |
$12K |
| A6545 |
Grad com non-elastic bk surg |
134 |
69 |
$8K |
| L5620 |
Test socket below knee |
43 |
38 |
$5K |
| L3216 |
Orthoped ladies shoes dpth i |
75 |
38 |
$5K |
| L1812 |
Ko elastic w/joints pre ots |
52 |
39 |
$4K |
| L5637 |
Below knee total contact |
25 |
24 |
$4K |
| L8420 |
Prosthetic sock multi ply bk |
74 |
65 |
$4K |
| L8400 |
Sheath below knee |
74 |
66 |
$4K |
| L5910 |
Endo below knee alignable sy |
25 |
24 |
$3K |
| L8440 |
Shrinker below knee |
32 |
27 |
$1K |
| L8470 |
Pros sock single ply bk |
61 |
54 |
$1K |
| L2820 |
Soft interface below knee se |
14 |
12 |
$768.17 |