| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| Q4205 |
Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure) |
322 |
133 |
$1.90M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14,507 |
12,713 |
$393K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,107 |
968 |
$388K |
| 11750 |
|
1,448 |
1,192 |
$203K |
| Q4131 |
Epifix or epicord, per square centimeter |
80 |
38 |
$201K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
3,210 |
3,202 |
$197K |
| 11721 |
|
5,205 |
5,049 |
$140K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
739 |
672 |
$109K |
| 11056 |
|
4,767 |
4,641 |
$101K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
627 |
569 |
$68K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
649 |
591 |
$63K |
| 99215 |
Prolong outpt/office vis |
868 |
791 |
$49K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
263 |
256 |
$44K |
| 99205 |
Prolong outpt/office vis |
440 |
436 |
$36K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,025 |
941 |
$31K |
| 15275 |
|
521 |
239 |
$22K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
66 |
65 |
$10K |
| 93925 |
|
67 |
67 |
$6K |
| 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 |
68 |
68 |
$6K |
| 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 |
68 |
68 |
$4K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
58 |
38 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
466 |
414 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
24 |
24 |
$2K |
| J3490 |
Unclassified drugs |
101 |
98 |
$29.93 |