| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
9,597 |
4,786 |
$432K |
| L3000 |
Ft insert ucb berkeley shell |
1,532 |
769 |
$350K |
| A6530 |
Compression stocking bk18-30 |
5,134 |
2,554 |
$214K |
| A5512 |
Multi den insert direct form |
5,483 |
2,744 |
$200K |
| L4361 |
Pneuma/vac walk boot pre ots |
768 |
753 |
$176K |
| A5513 |
Multi den insert custom mold |
3,382 |
1,849 |
$112K |
| A6533 |
Gc stocking thighlngth 18-30 |
1,155 |
570 |
$70K |
| L0633 |
Lso sc r pos/lat pnl pre cst |
312 |
304 |
$55K |
| A6539 |
Gc stocking waistlngth 18-30 |
370 |
301 |
$52K |
| L3908 |
Who cock-up nonmolde pre ots |
1,068 |
670 |
$49K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
42 |
42 |
$38K |
| L1906 |
Afo multilig ank sup pre ots |
325 |
292 |
$31K |
| L5000 |
Sho insert w arch toe filler |
73 |
63 |
$13K |
| L2820 |
Soft interface below knee se |
200 |
166 |
$11K |
| L1820 |
Ko elas w/ condyle pads & jo |
100 |
85 |
$8K |
| L8000 |
Mastectomy bra |
126 |
125 |
$7K |
| L2275 |
Plastic mod low ext pad/line |
97 |
80 |
$6K |
| A6545 |
Grad com non-elastic bk surg |
74 |
36 |
$6K |
| L1812 |
Ko elastic w/joints pre ots |
41 |
37 |
$4K |
| L8030 |
Breast prosthes w/o adhesive |
13 |
13 |
$3K |
| L0643 |
Lso sag ctr rigi pos pre ots |
13 |
13 |
$2K |