| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
406 |
209 |
$11K |
| L3040 |
Ft arch suprt premold longit |
407 |
209 |
$8K |
| L3224 |
Woman's shoe oxford brace |
518 |
267 |
$8K |
| L3225 |
Man's shoe oxford brace |
426 |
217 |
$8K |
| L1971 |
Afo w/ankle joint, prefab |
90 |
47 |
$5K |
| L1820 |
Ko elas w/ condyle pads & jo |
236 |
123 |
$5K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
82 |
82 |
$5K |
| L3807 |
Whfo w/o joints pre cst |
112 |
59 |
$4K |
| A5500 |
Diab shoe for density insert |
24 |
12 |
$713.16 |
| A5512 |
Multi den insert direct form |
24 |
12 |
$666.20 |
| L3060 |
Foot arch supp longitud/meta |
23 |
12 |
$361.31 |