| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2250 |
Foot plate molded stirrup at |
391 |
218 |
$127K |
| L2275 |
Plastic mod low ext pad/line |
1,062 |
601 |
$93K |
| L2270 |
Varus/valgus strap padded/li |
1,070 |
608 |
$93K |
| S1040 |
Cranial remolding orthosis |
24 |
24 |
$88K |
| L1940 |
Afo molded to patient plasti |
167 |
87 |
$61K |
| L1970 |
Afo plastic molded w/ankle j |
76 |
45 |
$38K |
| L4360 |
Pneumat walking boot pre cst |
161 |
154 |
$27K |
| A5500 |
Diab shoe for density insert |
368 |
208 |
$17K |
| L2220 |
Dorsi & plantar flex ass/res |
79 |
46 |
$10K |
| L3808 |
Whfo, rigid w/o joints |
37 |
24 |
$9K |
| A5513 |
Multi den insert custom mold |
70 |
37 |
$4K |