| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
502 |
349 |
$161K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
341 |
224 |
$37K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
102 |
75 |
$11K |
| L5704 |
Custom shaped protective cover, below knee |
81 |
61 |
$9K |
| L5962 |
Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
65 |
46 |
$6K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
212 |
139 |
$5K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
103 |
76 |
$4K |
| L5620 |
Addition to lower extremity, test socket, below knee |
67 |
47 |
$4K |
| L5637 |
Addition to lower extremity, below knee, total contact |
102 |
75 |
$4K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
75 |
58 |
$3K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
102 |
75 |
$3K |
| L8440 |
Prosthetic shrinker, below knee, each |
132 |
87 |
$2K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
244 |
162 |
$915.47 |