| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
1,297 |
1,290 |
$2.50M |
| L2280 |
Addition to lower extremity, molded inner boot |
1,232 |
954 |
$464K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
806 |
674 |
$421K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
863 |
699 |
$409K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,446 |
1,900 |
$264K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
438 |
370 |
$242K |
| L2999 |
Lower extremity orthoses, not otherwise specified |
2,247 |
1,622 |
$205K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
964 |
779 |
$170K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
690 |
679 |
$123K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,696 |
1,347 |
$104K |
| 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 |
151 |
145 |
$77K |
| 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 |
1,830 |
1,460 |
$70K |
| A4580 |
Cast supplies (e.g., plaster) |
848 |
788 |
$55K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
1,566 |
1,231 |
$48K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
1,270 |
1,046 |
$41K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 |
862 |
722 |
$29K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
424 |
411 |
$22K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
68 |
64 |
$13K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
57 |
53 |
$13K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
218 |
186 |
$12K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
54 |
51 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
335 |
333 |
$10K |
| L5620 |
Addition to lower extremity, test socket, below knee |
55 |
51 |
$10K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
171 |
164 |
$9K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
39 |
36 |
$9K |
| L5637 |
Addition to lower extremity, below knee, total contact |
58 |
54 |
$8K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
95 |
82 |
$7K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
13 |
13 |
$6K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
76 |
55 |
$6K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
136 |
131 |
$6K |
| 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 |
375 |
303 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
352 |
350 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
364 |
361 |
$4K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
14 |
14 |
$2K |
| 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 |
42 |
41 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
59 |
57 |
$2K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
15 |
14 |
$274.66 |