| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2280 |
Molded inner boot |
3,653 |
2,352 |
$1.03M |
| L1970 |
Afo plastic molded w/ankle j |
2,422 |
1,552 |
$836K |
| L1960 |
Afo pos solid ank plastic mo |
1,951 |
1,284 |
$648K |
| L1005 |
Tension based scoliosis orth |
254 |
229 |
$420K |
| L2275 |
Plastic mod low ext pad/line |
5,611 |
3,543 |
$399K |
| L1907 |
Afo supramalleolar custom |
752 |
445 |
$271K |
| L2210 |
Dorsiflexion assist each joi |
2,268 |
1,464 |
$139K |
| L2820 |
Soft interface below knee se |
3,002 |
1,900 |
$135K |
| L5673 |
Socket insert w lock mech |
230 |
188 |
$102K |
| L1930 |
Afo plastic |
752 |
355 |
$101K |
| A5500 |
Diab shoe for density insert |
3,768 |
1,556 |
$100K |
| A5512 |
Multi den insert direct form |
1,400 |
591 |
$40K |
| L5620 |
Test socket below knee |
228 |
184 |
$36K |
| L8420 |
Prosthetic sock multi ply bk |
467 |
369 |
$31K |
| L3020 |
Foot longitud/metatarsal sup |
297 |
159 |
$30K |
| L5637 |
Below knee total contact |
313 |
245 |
$29K |
| L5671 |
Bk/ak locking mechanism |
156 |
139 |
$28K |
| L5910 |
Endo below knee alignable sy |
213 |
171 |
$21K |
| A5513 |
Multi den insert custom mold |
929 |
334 |
$20K |
| S1040 |
Cranial remolding orthosis |
12 |
12 |
$20K |
| L5679 |
Socket insert w/o lock mech |
52 |
36 |
$19K |
| L5986 |
Multi-axial rotation unit |
49 |
41 |
$17K |
| L5301 |
Bk mold socket sach ft endo |
14 |
12 |
$9K |
| L5645 |
Bk flex inner socket ext fra |
58 |
38 |
$8K |
| L2780 |
Non-corrosive finish |
105 |
76 |
$7K |
| L2755 |
Carbon graphite lamination |
112 |
78 |
$6K |
| L5940 |
Endo bk ultra-light material |
60 |
40 |
$5K |
| L5629 |
Below knee acrylic socket |
61 |
41 |
$4K |
| L4205 |
Ortho dvc repair per 15 min |
48 |
38 |
$2K |
| L2220 |
Dorsi & plantar flex ass/res |
16 |
14 |
$424.61 |