| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
1,329 |
664 |
$271K |
| L2112 |
Afo tibial fracture soft |
704 |
701 |
$196K |
| L3030 |
Foot arch support remov prem |
3,012 |
1,507 |
$163K |
| S1040 |
Cranial remolding orthosis |
53 |
53 |
$96K |
| L1833 |
Ko adj jnt pos r sup pre ots |
203 |
182 |
$85K |
| L3809 |
Whfo w/o joints pre ots |
194 |
186 |
$23K |
| L2275 |
Plastic mod low ext pad/line |
274 |
150 |
$21K |
| L3908 |
Who cock-up nonmolde pre ots |
362 |
291 |
$15K |
| A5500 |
Diab shoe for density insert |
173 |
87 |
$9K |
| L0648 |
Lso sag r an/pos pnl pre ots |
12 |
12 |
$7K |
| L3807 |
Whfo w/o joints pre cst |
31 |
29 |
$4K |
| L3221 |
Orthopedic mens shoes dpth i |
67 |
34 |
$3K |
| E0114 |
Crutch underarm pair no wood |
72 |
71 |
$2K |
| L2820 |
Soft interface below knee se |
40 |
27 |
$2K |
| A5512 |
Multi den insert direct form |
80 |
40 |
$2K |
| L3202 |
Oxford w/ supinat/pronator c |
54 |
27 |
$2K |
| L3216 |
Orthoped ladies shoes dpth i |
36 |
18 |
$1K |
| L4361 |
Pneuma/vac walk boot pre ots |
14 |
14 |
$1K |
| L3332 |
Shoe lifts tapered to one-ha |
26 |
26 |
$1K |
| A5513 |
Multi den insert custom mold |
23 |
12 |
$754.86 |