| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
2,344 |
2,323 |
$781K |
| L3310 |
Shoe lift elev heel/sole neo |
872 |
869 |
$80K |
| L2820 |
Soft interface below knee se |
624 |
615 |
$48K |
| A5500 |
Diab shoe for density insert |
673 |
537 |
$36K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
65 |
62 |
$36K |
| L2275 |
Plastic mod low ext pad/line |
211 |
209 |
$26K |
| L4396 |
Static or dynami afo pre cst |
198 |
196 |
$22K |
| L3215 |
Orthopedic ftwear ladies oxf |
152 |
151 |
$14K |
| A5512 |
Multi den insert direct form |
367 |
283 |
$8K |
| L3219 |
Orthopedic mens shoes oxford |
52 |
52 |
$6K |
| L3206 |
Hightop w/ supp/pronator chi |
55 |
55 |
$3K |
| L3020 |
Foot longitud/metatarsal sup |
13 |
13 |
$2K |
| A4450 |
Non-waterproof tape |
74 |
69 |
$1K |
| A5513 |
Multi den insert custom mold |
29 |
28 |
$1K |
| A6446 |
Conform band s w>=3" <5"/yd |
104 |
96 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
125 |
116 |
$639.31 |
| A4217 |
Sterile water/saline, 500 ml |
21 |
19 |
$296.00 |