| S1040 | Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) | 8 | 10 | 1,020 | $1,380 | $1.9M |
| L2280 | Addition to lower extremity, molded inner boot | 3 | 10 | 1,000 | $660 | $883.8K |
| L5673 | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or… | 1 | 10 | 740 | $750 | $557.8K |
| L0621 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | 5 | 10 | 1,400 | $60 | $330.2K |
| L1970 | Ankle foot orthosis, plastic with ankle joint, custom fabricated | 1 | 10 | 160 | $670 | $268.3K |
| L1960 | Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated | 2 | 10 | 40 | $630 | $177.8K |
| L1907 | Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated | 1 | 10 | 330 | $670 | $162.6K |
| L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf | 1 | 10 | 660 | $220 | $147.2K |
| L3000 | Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each | 8 | 40 | 320 | $220 | $127.9K |
| L3010 | Foot, insert, removable, molded to patient model, longitudinal arch support, each | 1 | 30 | 230 | $200 | $124.1K |