| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1970 |
Afo plastic molded w/ankle j |
1,900 |
1,032 |
$705K |
| L2280 |
Molded inner boot |
1,735 |
850 |
$473K |
| L2275 |
Plastic mod low ext pad/line |
3,872 |
2,014 |
$273K |
| L1960 |
Afo pos solid ank plastic mo |
544 |
272 |
$153K |
| L2820 |
Soft interface below knee se |
2,332 |
1,301 |
$96K |
| L2200 |
Limited ankle motion ea jnt |
625 |
348 |
$33K |
| S1040 |
Cranial remolding orthosis |
13 |
12 |
$26K |
| L2220 |
Dorsi & plantar flex ass/res |
237 |
120 |
$20K |
| L1907 |
Afo supramalleolar custom |
30 |
16 |
$12K |
| A5500 |
Diab shoe for density insert |
171 |
111 |
$7K |
| A5513 |
Multi den insert custom mold |
163 |
107 |
$4K |
| L3020 |
Foot longitud/metatarsal sup |
18 |
13 |
$3K |