| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
66 |
66 |
$518.78 |
| 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 |
62 |
62 |
$67.04 |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
12 |
12 |
$0.00 |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
66 |
66 |
$0.00 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
67 |
67 |
$0.00 |
| 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 |
12 |
12 |
$0.00 |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
41 |
41 |
$0.00 |