| L3219 | Orthopedic footwear, mens shoe, oxford, each |
| L3530 | Orthopedic shoe addition, sole, half |
| L3540 | Orthopedic shoe addition, sole, full |
| L3257 | Orthopedic footwear, additional charge for split size |
| L3206 | Orthopedic shoe, hightop with supinator or pronator, child |
| L3202 | Orthopedic shoe, oxford with supinator or pronator, child |
| L3590 | Orthopedic shoe addition, convert firm shoe counter to soft counter |
| L3520 | Orthopedic shoe addition, insole, felt covered with leather |
| L3230 | Orthopedic footwear, custom shoe, depth inlay, each |
| L3221 | Orthopedic footwear, mens shoe, depth inlay, each |
| L3222 | Orthopedic footwear, mens shoe, hightop, depth inlay, each |
| L3570 | Orthopedic shoe addition, special extension to instep (leather with eyelets) |
| L3560 | Orthopedic shoe addition, toe tap, horseshoe |
| L3204 | Orthopedic shoe, hightop with supinator or pronator, infant |
| L3201 | Orthopedic shoe, oxford with supinator or pronator, infant |
| L3224 | Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
| L3225 | Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
| L3207 | Orthopedic shoe, hightop with supinator or pronator, junior |
| L3203 | Orthopedic shoe, oxford with supinator or pronator, junior |
| L3215 | Orthopedic footwear, ladies shoe, oxford, each |
| L3216 | Orthopedic footwear, ladies shoe, depth inlay, each |
| L3217 | Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
| L3500 | Orthopedic shoe addition, insole, leather |
| S8262 | Mandibular orthopedic repositioning device, each |
| L3595 | Orthopedic shoe addition, march bar |
| L3510 | Orthopedic shoe addition, insole, rubber |
| G4021 | Orthopedic surgery mips specialty set |
| L3649 | Orthopedic shoe, modification, addition or transfer, not otherwise specified |
| L3550 | Orthopedic shoe addition, toe tap standard |
