| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3001 |
Foot insert remov molded spe |
1,611 |
815 |
$129K |
| L3410 |
Shoe metatarsal bar between |
2,591 |
1,310 |
$119K |
| L3030 |
Foot arch support remov prem |
1,986 |
1,004 |
$95K |
| L3390 |
Shoe outflare wedge |
3,545 |
1,793 |
$88K |
| L3485 |
Shoe heel pad removable for |
2,120 |
1,068 |
$52K |
| L3202 |
Oxford w/ supinat/pronator c |
982 |
495 |
$24K |
| L3206 |
Hightop w/ supp/pronator chi |
957 |
483 |
$24K |
| K0553 |
Ther cgm supply allowance |
517 |
511 |
$19K |
| L3340 |
Shoe wedge sach |
454 |
232 |
$15K |
| A4239 |
Non-adju cgm supply allow |
309 |
301 |
$15K |
| L3222 |
Mens shoes hightop depth inl |
219 |
110 |
$15K |
| L3207 |
Hightop w/ supp/pronator jun |
587 |
298 |
$15K |
| L3217 |
Ladies shoes hightop depth i |
250 |
126 |
$14K |
| E0570 |
Nebulizer with compression |
127 |
127 |
$11K |
| S8101 |
Spacer with mask |
171 |
171 |
$7K |
| L3216 |
Orthoped ladies shoes dpth i |
222 |
112 |
$7K |
| L3221 |
Orthopedic mens shoes dpth i |
157 |
79 |
$6K |
| A7005 |
Nondisposable nebulizer set |
105 |
105 |
$1K |