| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
2,344 |
2,323 |
$781K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
872 |
869 |
$80K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
624 |
615 |
$48K |
| 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 |
673 |
537 |
$36K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
65 |
62 |
$36K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
211 |
209 |
$26K |
| 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 |
198 |
196 |
$22K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
152 |
151 |
$14K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
367 |
283 |
$8K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
52 |
52 |
$6K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
55 |
55 |
$3K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
13 |
13 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
74 |
69 |
$1K |
| 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 |
29 |
28 |
$1K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
104 |
96 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
125 |
116 |
$639.31 |
| A4217 |
Sterile water/saline, 500 ml |
21 |
19 |
$296.00 |