| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Special supply, nos waiver |
310 |
299 |
$627K |
| L2275 |
Plastic mod low ext pad/line |
3,839 |
1,859 |
$257K |
| L2820 |
Soft interface below knee se |
1,858 |
933 |
$124K |
| L2270 |
Varus/valgus strap padded/li |
2,248 |
1,126 |
$85K |
| L2840 |
Tibial length sock fx or equ |
831 |
805 |
$53K |
| L2280 |
Molded inner boot |
202 |
103 |
$45K |
| T1999 |
Noc retail items andsupplies |
12 |
12 |
$24K |
| L1945 |
Afo molded plas rig ant tib |
24 |
12 |
$17K |
| L1970 |
Afo plastic molded w/ankle j |
67 |
37 |
$15K |
| L4210 |
Orth dev repair/repl minor p |
329 |
321 |
$14K |
| L1960 |
Afo pos solid ank plastic mo |
24 |
13 |
$5K |
| L1930 |
Afo plastic |
30 |
14 |
$3K |
| L2200 |
Limited ankle motion ea jnt |
68 |
37 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
53 |
50 |
$2K |