| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
858 |
852 |
$171K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
615 |
605 |
$143K |
| E0667 |
Segmental pneumatic appliance for use with pneumatic compressor, full leg |
544 |
369 |
$83K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,017 |
916 |
$36K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
568 |
562 |
$28K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
892 |
889 |
$19K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
28 |
28 |
$11K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
145 |
132 |
$10K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
275 |
225 |
$8K |
| 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 |
99 |
67 |
$7K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
14 |
13 |
$6K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
133 |
131 |
$6K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
15 |
15 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
154 |
152 |
$5K |
| 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 |
102 |
69 |
$4K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
24 |
24 |
$3K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
56 |
56 |
$2K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
17 |
15 |
$2K |
| E0935 |
Continuous passive motion exercise device for use on knee only |
13 |
13 |
$2K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
27 |
27 |
$1K |
| L3260 |
Surgical boot/shoe, each |
12 |
12 |
$312.90 |