| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
4,261 |
2,455 |
$831K |
| A5500 |
Diab shoe for density insert |
4,591 |
2,868 |
$281K |
| A5513 |
Multi den insert custom mold |
3,670 |
2,420 |
$201K |
| L1820 |
Ko elas w/ condyle pads & jo |
559 |
494 |
$45K |
| L2820 |
Soft interface below knee se |
591 |
523 |
$37K |
| A5507 |
Modification diabetic shoe |
1,013 |
783 |
$32K |
| A5512 |
Multi den insert direct form |
884 |
604 |
$28K |
| L3216 |
Orthoped ladies shoes dpth i |
179 |
179 |
$26K |
| L8030 |
Breast prosthes w/o adhesive |
123 |
114 |
$23K |
| A6545 |
Grad com non-elastic bk surg |
255 |
150 |
$19K |
| L3908 |
Who cock-up nonmolde pre ots |
424 |
295 |
$17K |
| L8000 |
Mastectomy bra |
258 |
248 |
$16K |
| L3221 |
Orthopedic mens shoes dpth i |
89 |
88 |
$13K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
40 |
40 |
$10K |
| L3809 |
Whfo w/o joints pre ots |
51 |
38 |
$8K |
| L1906 |
Afo multilig ank sup pre ots |
86 |
78 |
$5K |
| L4360 |
Pneumat walking boot pre cst |
56 |
56 |
$5K |
| L2275 |
Plastic mod low ext pad/line |
70 |
64 |
$4K |
| L2830 |
Soft interface above knee se |
17 |
17 |
$1K |