| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot longitudinal arch suppo |
1,215 |
829 |
$220K |
| A5500 |
Diab shoe for density insert |
2,070 |
1,281 |
$126K |
| A5514 |
Mult den insert dir carv/cam |
1,019 |
650 |
$47K |
| L4361 |
Pneuma/vac walk boot pre ots |
132 |
131 |
$13K |
| L2820 |
Soft interface below knee se |
44 |
40 |
$3K |
| L3670 |
So acro/clav can web pre ots |
87 |
86 |
$2K |
| L4360 |
Pneumat walking boot pre cst |
12 |
12 |
$1K |
| A6530 |
Compression stocking bk18-30 |
19 |
14 |
$914.93 |
| A5513 |
Multi den insert custom mold |
22 |
13 |
$875.67 |
| K0903 |
Mult den insert dir carv/cam |
15 |
12 |
$509.59 |
| L0625 |
Lo flex l1-below l5 pre ots |
12 |
12 |
$482.60 |
| L3260 |
Ambulatory surgical boot eac |
12 |
12 |
$429.82 |
| L0999 |
Add to spinal orthosis nos |
12 |
12 |
$200.48 |