| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
7,295 |
6,345 |
$1.09M |
| A4287 |
Disp col sto bag breast milk |
4,293 |
4,083 |
$140K |
| L2630 |
Pelvic control band & belt u |
1,018 |
978 |
$121K |
| L0621 |
Sio flex pelvic/sacr pre ots |
884 |
847 |
$38K |
| A6530 |
Compression stocking bk18-30 |
895 |
859 |
$24K |
| K1005 |
Disp col sto bag breast milk |
232 |
197 |
$6K |
| A4284 |
Replcmnt breast pump shield |
80 |
30 |
$114.58 |
| A4285 |
Replcmnt breast pump bottle |
50 |
29 |
$90.40 |
| A4281 |
Replacement breastpump tube |
78 |
29 |
$56.24 |
| A4282 |
Replacement breastpump adpt |
78 |
29 |
$21.50 |
| A4286 |
Replcmnt breastpump lok ring |
34 |
13 |
$0.00 |
| A4283 |
Replacement breastpump cap |
34 |
13 |
$0.00 |