| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
90 |
44 |
$21K |
| 11056 |
|
1,437 |
1,390 |
$11K |
| 11721 |
|
2,407 |
2,336 |
$10K |
| 11305 |
|
407 |
366 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
150 |
140 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
25 |
25 |
$932.69 |
| 11055 |
|
401 |
388 |
$859.09 |
| 95851 |
|
29 |
29 |
$131.88 |
| 97597 |
|
12 |
12 |
$99.66 |
| A4580 |
Cast supplies (e.g., plaster) |
29 |
29 |
$0.00 |
| S0395 |
Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic |
29 |
29 |
$0.00 |