| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis |
1,659 |
1,141 |
$1.68M |
| A8003 |
Hard protect helmet custom |
604 |
552 |
$1.24M |
| L1960 |
Afo pos solid ank plastic mo |
249 |
123 |
$99K |
| L2275 |
Plastic mod low ext pad/line |
458 |
282 |
$56K |
| L2820 |
Soft interface below knee se |
487 |
300 |
$44K |
| L2280 |
Molded inner boot |
137 |
55 |
$42K |
| L1930 |
Afo plastic |
31 |
14 |
$7K |
| L2270 |
Varus/valgus strap padded/li |
56 |
30 |
$3K |
| L4386 |
Non-pneum walk boot pre cst |
31 |
28 |
$3K |
| L2210 |
Dorsiflexion assist each joi |
42 |
13 |
$3K |
| L2220 |
Dorsi & plantar flex ass/res |
29 |
13 |
$3K |
| L4360 |
Pneumat walking boot pre cst |
16 |
15 |
$3K |