| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Pneuma/vac walk boot pre ots |
447 |
391 |
$59K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
51 |
41 |
$17K |
| L3670 |
So acro/clav can web pre ots |
284 |
267 |
$15K |
| L3809 |
Whfo w/o joints pre ots |
70 |
64 |
$8K |
| A5500 |
Diab shoe for density insert |
725 |
295 |
$8K |
| L3807 |
Whfo w/o joints pre cst |
142 |
107 |
$5K |
| L1932 |
Afo rig ant tib tcf/= custom |
22 |
15 |
$5K |
| A5514 |
Mult den insert dir carv/cam |
331 |
130 |
$5K |
| A5513 |
Multi den insert custom mold |
359 |
143 |
$5K |
| E0114 |
Crutch underarm pair no wood |
174 |
165 |
$5K |
| L2820 |
Soft interface below knee se |
43 |
28 |
$529.19 |