| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1960 |
Afo pos solid ank plastic mo |
2,616 |
1,569 |
$689K |
| L2820 |
Soft interface below knee se |
4,241 |
2,468 |
$235K |
| L2275 |
Plastic mod low ext pad/line |
3,361 |
1,917 |
$195K |
| L1200 |
Furnsh initial orthosis only |
64 |
57 |
$67K |
| L1210 |
Lateral thoracic extension |
252 |
236 |
$30K |
| L1930 |
Afo plastic |
215 |
112 |
$23K |
| L4386 |
Non-pneum walk boot pre cst |
280 |
271 |
$14K |
| L2280 |
Molded inner boot |
47 |
29 |
$9K |
| L1832 |
Ko adj jnt pos r sup pre cst |
26 |
26 |
$6K |
| L1970 |
Afo plastic molded w/ankle j |
17 |
12 |
$6K |
| L1907 |
Afo supramalleolar custom |
23 |
13 |
$5K |
| L2768 |
Ortho sidebar disconnect |
53 |
28 |
$4K |
| L1240 |
Lumbar derotation pad |
27 |
27 |
$632.79 |
| L3150 |
Abduct rotation bar w/o shoe |
13 |
13 |
$614.04 |
| L1290 |
Lateral trochanteric pad |
15 |
15 |
$533.49 |
| L1260 |
Anterior thoracic derotation |
14 |
14 |
$332.95 |
| L4205 |
Ortho dvc repair per 15 min |
13 |
12 |
$238.82 |
| L2999 |
Lower extremity orthosis nos |
15 |
12 |
$169.36 |