| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
124 |
73 |
$66K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
252 |
212 |
$44K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
348 |
200 |
$31K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
67 |
56 |
$23K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
40 |
32 |
$7K |
| L2280 |
Addition to lower extremity, molded inner boot |
28 |
12 |
$6K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
187 |
146 |
$6K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
100 |
65 |
$6K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
148 |
114 |
$5K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
38 |
27 |
$3K |
| 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 |
32 |
16 |
$248.20 |