| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
21 |
12 |
$9K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
150 |
143 |
$7K |
| 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 |
72 |
43 |
$3K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
44 |
26 |
$3K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
24 |
14 |
$2K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
45 |
26 |
$2K |
| A5503 |
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe |
64 |
39 |
$2K |
| A5504 |
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe |
66 |
40 |
$2K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
12 |
12 |
$776.91 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
20 |
13 |
$459.22 |