| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
725 |
662 |
$128K |
| 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 |
987 |
793 |
$101K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
912 |
642 |
$93K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
540 |
357 |
$36K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
167 |
117 |
$29K |
| L2280 |
Addition to lower extremity, molded inner boot |
42 |
39 |
$17K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
99 |
92 |
$15K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
14 |
12 |
$8K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
90 |
82 |
$7K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
190 |
167 |
$5K |
| 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 |
39 |
26 |
$5K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
16 |
12 |
$858.23 |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
22 |
15 |
$433.44 |