| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3410 |
Metatarsal bar wedge, between sole |
1,420 |
1,263 |
$146K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
533 |
479 |
$141K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
693 |
591 |
$137K |
| L3370 |
Sole wedge, between sole |
1,373 |
1,228 |
$85K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
729 |
696 |
$85K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
419 |
394 |
$43K |
| L3350 |
Heel wedge |
1,379 |
1,232 |
$40K |
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
19 |
14 |
$11K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
91 |
77 |
$10K |
| 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 |
190 |
115 |
$5K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
46 |
38 |
$5K |
| 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 |
125 |
77 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
82 |
70 |
$2K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
12 |
12 |
$2K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
13 |
$660.09 |