| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3030 |
Foot arch support remov prem |
19,614 |
9,828 |
$864K |
| L3000 |
Ft insert ucb berkeley shell |
5,136 |
2,567 |
$857K |
| L3219 |
Orthopedic mens shoes oxford |
9,011 |
4,508 |
$519K |
| L3170 |
Foot plas heel stabi pre ots |
20,943 |
10,498 |
$490K |
| L3215 |
Orthopedic ftwear ladies oxf |
9,957 |
4,985 |
$488K |
| L3390 |
Shoe outflare wedge |
18,617 |
9,324 |
$427K |
| L3400 |
Shoe metatarsal bar wedge ro |
8,645 |
4,330 |
$162K |
| L3206 |
Hightop w/ supp/pronator chi |
6,636 |
3,326 |
$141K |
| L3001 |
Foot insert remov molded spe |
1,509 |
751 |
$103K |
| L3320 |
Shoe lift elev heel/sole cor |
870 |
436 |
$41K |
| L1930 |
Afo plastic |
273 |
135 |
$30K |
| L3485 |
Shoe heel pad removable for |
847 |
425 |
$19K |
| L2768 |
Ortho sidebar disconnect |
271 |
135 |
$14K |
| L3160 |
Shoe styled positioning dev |
86 |
43 |
$7K |
| L2300 |
Abduction bar jointed adjust |
29 |
29 |
$6K |
| L3150 |
Abduct rotation bar w/o shoe |
137 |
135 |
$5K |
| L1971 |
Afo w/ankle joint, prefab |
24 |
12 |
$5K |
| L3430 |
Sho heel count plast reinfor |
318 |
160 |
$932.93 |
| L3202 |
Oxford w/ supinat/pronator c |
32 |
16 |
$735.36 |
| L2275 |
Plastic mod low ext pad/line |
35 |
19 |
$209.97 |