| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis |
1,297 |
1,290 |
$2.50M |
| L2280 |
Molded inner boot |
1,232 |
954 |
$464K |
| L1970 |
Afo plastic molded w/ankle j |
806 |
674 |
$421K |
| L1907 |
Afo supramalleolar custom |
863 |
699 |
$409K |
| L2275 |
Plastic mod low ext pad/line |
2,446 |
1,900 |
$264K |
| L1960 |
Afo pos solid ank plastic mo |
438 |
370 |
$242K |
| L2999 |
Lower extremity orthosis nos |
2,247 |
1,622 |
$205K |
| L3010 |
Foot longitudinal arch suppo |
964 |
779 |
$170K |
| L4361 |
Pneuma/vac walk boot pre ots |
690 |
679 |
$123K |
| L2820 |
Soft interface below knee se |
1,696 |
1,347 |
$104K |
| L5673 |
Socket insert w lock mech |
151 |
145 |
$77K |
| A5500 |
Diab shoe for density insert |
1,830 |
1,460 |
$70K |
| A4580 |
Cast supplies (plaster) |
848 |
788 |
$55K |
| L2270 |
Varus/valgus strap padded/li |
1,566 |
1,231 |
$48K |
| L3202 |
Oxford w/ supinat/pronator c |
1,270 |
1,046 |
$41K |
| A5514 |
Mult den insert dir carv/cam |
862 |
722 |
$29K |
| L1902 |
Afo ankle gauntlet pre ots |
424 |
411 |
$22K |
| L5671 |
Bk/ak locking mechanism |
68 |
64 |
$13K |
| L5629 |
Below knee acrylic socket |
57 |
53 |
$13K |
| L2220 |
Dorsi & plantar flex ass/res |
218 |
186 |
$12K |
| L5940 |
Endo bk ultra-light material |
54 |
51 |
$11K |
| A6446 |
Conform band s w>=3" <5"/yd |
335 |
333 |
$10K |
| L5620 |
Test socket below knee |
55 |
51 |
$10K |
| L8420 |
Prosthetic sock multi ply bk |
171 |
164 |
$9K |
| L5910 |
Endo below knee alignable sy |
39 |
36 |
$9K |
| L5637 |
Below knee total contact |
58 |
54 |
$8K |
| L2200 |
Limited ankle motion ea jnt |
95 |
82 |
$7K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
13 |
13 |
$6K |
| L3060 |
Foot arch supp longitud/meta |
76 |
55 |
$6K |
| L3908 |
Who cock-up nonmolde pre ots |
136 |
131 |
$6K |
| A5512 |
Multi den insert direct form |
375 |
303 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
352 |
350 |
$4K |
| A4452 |
Waterproof tape |
364 |
361 |
$4K |
| A6196 |
Alginate dressing <=16 sq in |
14 |
14 |
$2K |
| L1820 |
Ko elas w/ condyle pads & jo |
42 |
41 |
$2K |
| E0114 |
Crutch underarm pair no wood |
59 |
57 |
$2K |
| L8470 |
Pros sock single ply bk |
15 |
14 |
$274.66 |