| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,206 |
682 |
$226K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
2,210 |
1,105 |
$97K |
| L3410 |
Metatarsal bar wedge, between sole |
1,844 |
922 |
$79K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
1,470 |
735 |
$73K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
226 |
223 |
$50K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,336 |
695 |
$48K |
| L3480 |
Heel, pad and depression for spur |
2,564 |
1,282 |
$37K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
216 |
214 |
$25K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
830 |
426 |
$25K |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
248 |
124 |
$7K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
14 |
14 |
$3K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
45 |
38 |
$2K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
13 |
13 |
$546.00 |