| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3001 |
Foot insert remov molded spe |
8,918 |
4,733 |
$764K |
| E0575 |
Nebulizer ultrasonic |
1,980 |
1,980 |
$601K |
| L2275 |
Plastic mod low ext pad/line |
3,767 |
2,261 |
$346K |
| L3030 |
Foot arch support remov prem |
3,985 |
2,003 |
$190K |
| L3217 |
Ladies shoes hightop depth i |
2,847 |
1,569 |
$181K |
| L3000 |
Ft insert ucb berkeley shell |
430 |
430 |
$180K |
| E0570 |
Nebulizer with compression |
1,648 |
1,647 |
$139K |
| L3222 |
Mens shoes hightop depth inl |
1,823 |
1,018 |
$138K |
| A5500 |
Diab shoe for density insert |
2,488 |
1,328 |
$131K |
| L3202 |
Oxford w/ supinat/pronator c |
4,192 |
2,201 |
$109K |
| L3170 |
Foot plas heel stabi pre ots |
3,741 |
1,916 |
$97K |
| L3010 |
Foot longitudinal arch suppo |
639 |
460 |
$90K |
| L3215 |
Orthopedic ftwear ladies oxf |
1,219 |
682 |
$75K |
| L3219 |
Orthopedic mens shoes oxford |
844 |
474 |
$61K |
| L3216 |
Orthoped ladies shoes dpth i |
1,200 |
617 |
$53K |
| A5512 |
Multi den insert direct form |
2,349 |
1,253 |
$53K |
| S8101 |
Spacer with mask |
1,731 |
1,709 |
$43K |
| L1971 |
Afo w/ankle joint, prefab |
160 |
114 |
$39K |
| L3221 |
Orthopedic mens shoes dpth i |
625 |
323 |
$33K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
125 |
125 |
$31K |
| L4396 |
Static or dynami afo pre cst |
268 |
159 |
$31K |
| L3203 |
Oxford w/ supinator/pronator |
1,176 |
605 |
$30K |
| A7005 |
Nondisposable nebulizer set |
1,735 |
1,712 |
$25K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
98 |
98 |
$20K |
| L1930 |
Afo plastic |
99 |
65 |
$13K |
| A6530 |
Compression stocking bk18-30 |
594 |
309 |
$11K |
| L1820 |
Ko elas w/ condyle pads & jo |
97 |
74 |
$9K |
| A4670 |
Automatic bp monitor, dial |
102 |
101 |
$4K |
| L3206 |
Hightop w/ supp/pronator chi |
55 |
55 |
$3K |
| L3807 |
Whfo w/o joints pre cst |
13 |
12 |
$2K |