| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8699 |
Prosthetic implant, not otherwise specified |
6,843 |
6,026 |
$20.44M |
| 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 |
116 |
57 |
$86K |
| 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 |
836 |
470 |
$38K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
73 |
38 |
$36K |
| 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 |
654 |
417 |
$34K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
86 |
41 |
$18K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
24 |
12 |
$7K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
26 |
13 |
$6K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
13 |
12 |
$4K |
| L5962 |
Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
14 |
12 |
$2K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
51 |
29 |
$611.16 |