| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
2,431 |
1,576 |
$388K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
1,318 |
818 |
$85K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
1,562 |
938 |
$62K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,084 |
732 |
$60K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
635 |
417 |
$36K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
19 |
13 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
45 |
26 |
$2K |