| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
12,274 |
6,135 |
$2.28M |
| L3001 |
Foot insert remov molded spe |
8,224 |
4,712 |
$890K |
| L3410 |
Shoe metatarsal bar between |
10,436 |
5,242 |
$632K |
| L3215 |
Orthopedic ftwear ladies oxf |
6,191 |
3,292 |
$396K |
| L3219 |
Orthopedic mens shoes oxford |
4,623 |
2,453 |
$346K |
| L2275 |
Plastic mod low ext pad/line |
2,033 |
1,849 |
$236K |
| L3485 |
Shoe heel pad removable for |
7,044 |
3,536 |
$232K |
| L3370 |
Shoe sole wedge between sole |
6,285 |
3,160 |
$195K |
| L3202 |
Oxford w/ supinat/pronator c |
6,905 |
3,471 |
$190K |
| A7030 |
Cpap full face mask |
798 |
791 |
$74K |
| L3010 |
Foot longitudinal arch suppo |
486 |
481 |
$71K |
| L3216 |
Orthoped ladies shoes dpth i |
1,197 |
814 |
$46K |
| L3221 |
Orthopedic mens shoes dpth i |
961 |
665 |
$44K |
| A7031 |
Replacement facemask interfa |
1,055 |
1,047 |
$42K |
| L2112 |
Afo tibial fracture soft |
151 |
151 |
$35K |
| A4554 |
Disposable underpads |
372 |
353 |
$23K |
| E0570 |
Nebulizer with compression |
296 |
293 |
$23K |
| A7035 |
Pos airway press headgear |
1,068 |
1,063 |
$13K |
| L3390 |
Shoe outflare wedge |
390 |
197 |
$12K |
| A7036 |
Pos airway press chinstrap |
1,203 |
1,192 |
$11K |
| A7037 |
Pos airway pressure tubing |
1,066 |
1,061 |
$9K |
| E0601 |
Cont airway pressure device |
24 |
24 |
$7K |
| L3217 |
Ladies shoes hightop depth i |
130 |
65 |
$7K |
| L3809 |
Whfo w/o joints pre ots |
59 |
58 |
$6K |
| A7005 |
Nondisposable nebulizer set |
252 |
250 |
$3K |
| E0114 |
Crutch underarm pair no wood |
186 |
185 |
$3K |
| L3908 |
Who cock-up nonmolde pre ots |
106 |
105 |
$3K |
| E0562 |
Humidifier heated used w pap |
28 |
26 |
$3K |
| A7038 |
Pos airway pressure filter |
1,045 |
1,041 |
$2K |
| T4537 |
Reusable underpad bed size |
53 |
51 |
$2K |
| A7034 |
Nasal application device |
57 |
57 |
$2K |
| A7039 |
Filter, non disposable w pap |
1,131 |
1,124 |
$2K |
| L3222 |
Mens shoes hightop depth inl |
28 |
14 |
$2K |
| A4927 |
Non-sterile gloves |
376 |
360 |
$1K |
| L3260 |
Ambulatory surgical boot eac |
69 |
69 |
$1K |
| K1005 |
Disp col sto bag breast milk |
12 |
12 |
$504.00 |
| A7033 |
Replacement nasal pillows |
17 |
17 |
$233.74 |
| L1930 |
Afo plastic |
12 |
12 |
$126.10 |