| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5940 |
Endo bk ultra-light material |
115 |
99 |
$16K |
| L5637 |
Below knee total contact |
118 |
102 |
$11K |
| L5673 |
Socket insert w lock mech |
42 |
37 |
$11K |
| L5645 |
Bk flex inner socket ext fra |
72 |
63 |
$10K |
| L5704 |
Custom shape cover bk |
74 |
64 |
$10K |
| L5620 |
Test socket below knee |
71 |
62 |
$8K |
| L5671 |
Bk/ak locking mechanism |
58 |
51 |
$7K |
| L5679 |
Socket insert w/o lock mech |
28 |
25 |
$6K |
| L5629 |
Below knee acrylic socket |
59 |
51 |
$5K |
| L5647 |
Below knee suction socket |
14 |
13 |
$3K |
| L2275 |
Plastic mod low ext pad/line |
17 |
14 |
$638.66 |
| L2820 |
Soft interface below knee se |
17 |
14 |
$492.73 |
| L2210 |
Dorsiflexion assist each joi |
17 |
14 |
$476.77 |
| L5685 |
Below knee sus/seal sleeve |
14 |
13 |
$459.83 |