| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis |
244 |
203 |
$537K |
| L2280 |
Molded inner boot |
1,015 |
440 |
$260K |
| L1960 |
Afo pos solid ank plastic mo |
447 |
185 |
$145K |
| L2275 |
Plastic mod low ext pad/line |
1,866 |
789 |
$129K |
| L2840 |
Tibial length sock fx or equ |
1,303 |
564 |
$80K |
| L1970 |
Afo plastic molded w/ankle j |
159 |
70 |
$69K |
| L1907 |
Afo supramalleolar custom |
149 |
64 |
$47K |
| L2820 |
Soft interface below knee se |
467 |
213 |
$23K |
| L3202 |
Oxford w/ supinat/pronator c |
364 |
158 |
$9K |
| L3906 |
Who w/o joints cf |
29 |
12 |
$8K |
| L3203 |
Oxford w/ supinator/pronator |
200 |
85 |
$6K |
| L2200 |
Limited ankle motion ea jnt |
53 |
24 |
$3K |