| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
1,976 |
1,466 |
$232K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
1,340 |
1,030 |
$188K |
| L2280 |
Addition to lower extremity, molded inner boot |
166 |
125 |
$69K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
792 |
600 |
$50K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
889 |
680 |
$42K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
17 |
14 |
$12K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
232 |
167 |
$12K |
| 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 |
193 |
142 |
$6K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
43 |
24 |
$3K |
| L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
15 |
12 |
$1K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
13 |
13 |
$1K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
13 |
12 |
$929.67 |
| L8400 |
Prosthetic sheath, below knee, each |
12 |
12 |
$554.35 |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
13 |
13 |
$272.59 |