| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot longitud/metatarsal sup |
1,976 |
1,466 |
$232K |
| L2275 |
Plastic mod low ext pad/line |
1,340 |
1,030 |
$188K |
| L2280 |
Molded inner boot |
166 |
125 |
$69K |
| L2820 |
Soft interface below knee se |
792 |
600 |
$50K |
| L2270 |
Varus/valgus strap padded/li |
889 |
680 |
$42K |
| L5673 |
Socket insert w lock mech |
17 |
14 |
$12K |
| A5513 |
Multi den insert custom mold |
232 |
167 |
$12K |
| A5500 |
Diab shoe for density insert |
193 |
142 |
$6K |
| L2220 |
Dorsi & plantar flex ass/res |
43 |
24 |
$3K |
| L0174 |
Cerv sr 2pc thor ext pre ots |
15 |
12 |
$1K |
| L8420 |
Prosthetic sock multi ply bk |
13 |
13 |
$1K |
| L3216 |
Orthoped ladies shoes dpth i |
13 |
12 |
$929.67 |
| L8400 |
Sheath below knee |
12 |
12 |
$554.35 |
| L8470 |
Pros sock single ply bk |
13 |
13 |
$272.59 |