| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
115 |
99 |
$16K |
| L5637 |
Addition to lower extremity, below knee, total contact |
118 |
102 |
$11K |
| 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 |
42 |
37 |
$11K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
72 |
63 |
$10K |
| L5704 |
Custom shaped protective cover, below knee |
74 |
64 |
$10K |
| L5620 |
Addition to lower extremity, test socket, below knee |
71 |
62 |
$8K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
58 |
51 |
$7K |
| L5679 |
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, not for use with locking mechanism |
28 |
25 |
$6K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
59 |
51 |
$5K |
| L5647 |
Addition to lower extremity, below knee suction socket |
14 |
13 |
$3K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
17 |
14 |
$638.66 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
17 |
14 |
$492.73 |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
17 |
14 |
$476.77 |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
14 |
13 |
$459.83 |