| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,329 |
664 |
$271K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
704 |
701 |
$196K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
3,012 |
1,507 |
$163K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
53 |
53 |
$96K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
203 |
182 |
$85K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
194 |
186 |
$23K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
274 |
150 |
$21K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
362 |
291 |
$15K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
173 |
87 |
$9K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$7K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
31 |
29 |
$4K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
67 |
34 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
72 |
71 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
40 |
27 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
80 |
40 |
$2K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
54 |
27 |
$2K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
36 |
18 |
$1K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
14 |
14 |
$1K |
| L3332 |
Lift, elevation, inside shoe, tapered, up to one-half inch |
26 |
26 |
$1K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
23 |
12 |
$754.86 |