| L1846 | Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment,… | 1 | 10 | 330 | $880 | $291.2K |
| L1833 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | 1 | 10 | 220 | $410 | $140.4K |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 2 | 10 | 330 | $140 | $111.5K |
| L2820 | Addition to lower extremity orthosis, soft interface for molded plastic, below knee section | 3 | 10 | 240 | $50 | $84.2K |
| L3809 | Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type | 1 | 10 | 710 | $120 | $79.4K |
| 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 | 3 | 10 | 220 | $50 | $74.4K |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | 6 | 10 | 290 | $70 | $58K |
| L2425 | Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint | 1 | 10 | 250 | $210 | $51K |
| L2755 | Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only | 1 | 10 | 330 | $140 | $46.1K |
| L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment | 2 | 10 | 110 | $170 | $32.5K |