| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
25,645 |
13,112 |
$4.90M |
| L3002 |
Foot insert plastazote or eq |
12,057 |
5,902 |
$1.24M |
| L3219 |
Orthopedic mens shoes oxford |
17,329 |
8,667 |
$1.19M |
| L3215 |
Orthopedic ftwear ladies oxf |
18,012 |
9,069 |
$1.03M |
| L3010 |
Foot longitudinal arch suppo |
8,644 |
4,482 |
$688K |
| L2275 |
Plastic mod low ext pad/line |
15,118 |
7,974 |
$662K |
| L3030 |
Foot arch support remov prem |
6,796 |
3,473 |
$414K |
| L3480 |
Shoe heel pad & depress for |
25,908 |
13,019 |
$402K |
| L3202 |
Oxford w/ supinat/pronator c |
11,724 |
5,984 |
$295K |
| T4535 |
Disposable liner/shield/pad |
6,204 |
6,184 |
$172K |
| L3410 |
Shoe metatarsal bar between |
3,003 |
1,551 |
$152K |
| A4554 |
Disposable underpads |
5,016 |
5,007 |
$143K |
| A5500 |
Diab shoe for density insert |
3,519 |
1,820 |
$122K |
| T4523 |
Adult size brief/diaper lg |
1,583 |
1,575 |
$116K |
| T4524 |
Adult size brief/diaper xl |
1,498 |
1,495 |
$107K |
| L3216 |
Orthoped ladies shoes dpth i |
2,060 |
1,082 |
$84K |
| L3221 |
Orthopedic mens shoes dpth i |
1,654 |
854 |
$80K |
| L3001 |
Foot insert remov molded spe |
992 |
499 |
$76K |
| L3203 |
Oxford w/ supinator/pronator |
1,159 |
685 |
$41K |
| T4539 |
Reuse diaper/brief any size |
1,446 |
1,432 |
$41K |
| A5512 |
Multi den insert direct form |
2,475 |
1,298 |
$36K |
| T4522 |
Adult size brief/diaper med |
453 |
452 |
$28K |
| L2755 |
Carbon graphite lamination |
219 |
159 |
$14K |
| T4537 |
Reusable underpad bed size |
125 |
125 |
$4K |
| A4927 |
Non-sterile gloves |
1,171 |
1,119 |
$4K |
| L2114 |
Afo tib fx semi-rigid |
12 |
12 |
$4K |
| L3360 |
Shoe sole wedge outside sole |
76 |
38 |
$1K |
| A6533 |
Gc stocking thighlngth 18-30 |
24 |
12 |
$966.02 |