| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0643 |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
15,248 |
15,157 |
$438K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
10,746 |
10,666 |
$373K |
| L0649 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
2,088 |
2,086 |
$140K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
5,035 |
4,968 |
$66K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
971 |
561 |
$28K |
| E1399 |
Durable medical equipment, miscellaneous |
2,848 |
2,748 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
593 |
403 |
$6K |
| L0628 |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
378 |
374 |
$3K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
48 |
48 |
$1K |
| S9999 |
Sales tax |
159 |
159 |
$1K |
| A4285 |
Polycarbonate bottle for use with breast pump, replacement |
25 |
25 |
$373.44 |
| A4284 |
Breast shield and splash protector for use with breast pump, replacement |
25 |
25 |
$286.56 |
| E0602 |
Breast pump, manual, any type |
918 |
911 |
$187.44 |
| A4282 |
Adapter for breast pump, replacement |
25 |
25 |
$167.52 |
| A4281 |
Tubing for breast pump, replacement |
26 |
25 |
$143.92 |
| A4283 |
Cap for breast pump bottle, replacement |
25 |
25 |
$97.92 |
| A4286 |
Locking ring for breast pump, replacement |
25 |
25 |
$59.40 |