| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0650 |
Lso sc r ant/pos pnl pre ots |
102 |
102 |
$86K |
| L3908 |
Who cock-up nonmolde pre ots |
304 |
265 |
$18K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
54 |
54 |
$14K |
| A5500 |
Diab shoe for density insert |
265 |
168 |
$14K |
| L1820 |
Ko elas w/ condyle pads & jo |
134 |
125 |
$12K |
| L5940 |
Endo bk ultra-light material |
52 |
51 |
$9K |
| L5637 |
Below knee total contact |
53 |
52 |
$8K |
| A5513 |
Multi den insert custom mold |
115 |
83 |
$7K |
| L5620 |
Test socket below knee |
53 |
52 |
$4K |
| L8420 |
Prosthetic sock multi ply bk |
67 |
67 |
$3K |
| L5629 |
Below knee acrylic socket |
52 |
51 |
$3K |
| L4361 |
Pneuma/vac walk boot pre ots |
15 |
15 |
$3K |
| L5910 |
Endo below knee alignable sy |
25 |
24 |
$3K |
| L3809 |
Whfo w/o joints pre ots |
15 |
14 |
$2K |
| L2275 |
Plastic mod low ext pad/line |
29 |
28 |
$2K |
| L2820 |
Soft interface below knee se |
13 |
12 |
$1K |
| L8400 |
Sheath below knee |
12 |
12 |
$816.14 |