| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
10,174 |
5,173 |
$1.65M |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
1,998 |
1,982 |
$451K |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
1,166 |
1,166 |
$285K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,283 |
1,722 |
$173K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
3,691 |
1,893 |
$171K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
3,057 |
1,555 |
$163K |
| L3915 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
637 |
420 |
$133K |
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
412 |
409 |
$121K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,240 |
1,163 |
$117K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
4,045 |
2,037 |
$91K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,937 |
2,875 |
$88K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
250 |
203 |
$70K |
| E0570 |
Nebulizer, with compressor |
1,041 |
1,030 |
$70K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
224 |
222 |
$64K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
355 |
266 |
$58K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,050 |
534 |
$46K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
233 |
178 |
$45K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,413 |
1,387 |
$19K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
973 |
969 |
$19K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
137 |
136 |
$16K |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
95 |
91 |
$14K |
| L0180 |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
148 |
148 |
$14K |
| L3260 |
Surgical boot/shoe, each |
1,079 |
1,073 |
$13K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
228 |
220 |
$13K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
408 |
395 |
$13K |
| 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 |
508 |
254 |
$12K |
| 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 |
566 |
288 |
$11K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
248 |
130 |
$10K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
296 |
293 |
$9K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
191 |
187 |
$9K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
49 |
40 |
$9K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
372 |
189 |
$8K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
81 |
41 |
$7K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
96 |
77 |
$5K |
| E0650 |
Pneumatic compressor, non-segmental home model |
59 |
59 |
$5K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
55 |
28 |
$4K |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
12 |
12 |
$3K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
78 |
48 |
$2K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
13 |
12 |
$2K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
94 |
61 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,388 |
1,341 |
$1K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
12 |
12 |
$462.00 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,329 |
1,289 |
$134.79 |