| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0643 |
Lso sag ctr rigi pos pre ots |
15,248 |
15,157 |
$438K |
| E0603 |
Electric breast pump |
10,746 |
10,666 |
$373K |
| L0649 |
Lso sc r pos/lat pnl pre ots |
2,088 |
2,086 |
$140K |
| L2630 |
Pelvic control band & belt u |
5,035 |
4,968 |
$66K |
| A6545 |
Grad com non-elastic bk surg |
971 |
561 |
$28K |
| E1399 |
Durable medical equipment mi |
2,848 |
2,748 |
$8K |
| L3908 |
Who cock-up nonmolde pre ots |
593 |
403 |
$6K |
| L0628 |
Lso flex no ri stays pre ots |
378 |
374 |
$3K |
| A4239 |
Non-adju cgm supply allow |
48 |
48 |
$1K |
| S9999 |
Sales tax |
159 |
159 |
$1K |
| A4285 |
Replcmnt breast pump bottle |
25 |
25 |
$373.44 |
| A4284 |
Replcmnt breast pump shield |
25 |
25 |
$286.56 |
| E0602 |
Manual breast pump |
918 |
911 |
$187.44 |
| A4282 |
Replacement breastpump adpt |
25 |
25 |
$167.52 |
| A4281 |
Replacement breastpump tube |
26 |
25 |
$143.92 |
| A4283 |
Replacement breastpump cap |
25 |
25 |
$97.92 |
| A4286 |
Replcmnt breastpump lok ring |
25 |
25 |
$59.40 |