| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
1,206 |
682 |
$226K |
| L3030 |
Foot arch support remov prem |
2,210 |
1,105 |
$97K |
| L3410 |
Shoe metatarsal bar between |
1,844 |
922 |
$79K |
| L3215 |
Orthopedic ftwear ladies oxf |
1,470 |
735 |
$73K |
| A6540 |
Gc stocking waistlngth 30-40 |
226 |
223 |
$50K |
| L3221 |
Orthopedic mens shoes dpth i |
1,336 |
695 |
$48K |
| L3480 |
Shoe heel pad & depress for |
2,564 |
1,282 |
$37K |
| A6539 |
Gc stocking waistlngth 18-30 |
216 |
214 |
$25K |
| L3216 |
Orthoped ladies shoes dpth i |
830 |
426 |
$25K |
| L3001 |
Foot insert remov molded spe |
248 |
124 |
$7K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
14 |
14 |
$3K |
| L3206 |
Hightop w/ supp/pronator chi |
45 |
38 |
$2K |
| A4287 |
Disp col sto bag breast milk |
13 |
13 |
$546.00 |