| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
100,560 |
78,197 |
$11.08M |
| E0570 |
Nebulizer with compression |
53,366 |
43,337 |
$4.49M |
| A4670 |
Automatic bp monitor, dial |
32,332 |
28,846 |
$2.02M |
| A7005 |
Nondisposable nebulizer set |
54,518 |
44,902 |
$1.36M |
| L0621 |
Sio flex pelvic/sacr pre ots |
21,025 |
18,563 |
$1.34M |
| K1005 |
Disp col sto bag breast milk |
31,573 |
27,667 |
$1.17M |
| A7000 |
Disposable canister for pump |
54,468 |
44,235 |
$804K |
| L8310 |
Truss double w/ standard pad |
6,267 |
5,337 |
$749K |
| A4287 |
Disp col sto bag breast milk |
14,954 |
11,979 |
$517K |
| A7002 |
Tubing used w suction pump |
54,436 |
44,194 |
$343K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
1,049 |
824 |
$323K |
| T4541 |
Large disposable underpad |
3,750 |
2,975 |
$269K |
| T4528 |
Adult size pull-on xl |
1,260 |
1,014 |
$219K |
| A6530 |
Compression stocking bk18-30 |
2,177 |
1,846 |
$142K |
| T4535 |
Disposable liner/shield/pad |
2,892 |
2,450 |
$141K |
| T4526 |
Adult size pull-on med |
884 |
776 |
$124K |
| T4534 |
Youth size pull-on |
1,027 |
797 |
$106K |
| L2630 |
Pelvic control band & belt u |
504 |
491 |
$100K |
| T4527 |
Adult size pull-on lg |
630 |
549 |
$88K |
| A7015 |
Aerosol mask used w nebulize |
54,330 |
44,956 |
$82K |
| T4544 |
Adlt disp und/pull on abv xl |
256 |
204 |
$66K |
| T4524 |
Adult size brief/diaper xl |
239 |
184 |
$37K |
| A4284 |
Replcmnt breast pump shield |
5,159 |
5,070 |
$33K |
| A4927 |
Non-sterile gloves |
3,975 |
3,086 |
$31K |
| A4663 |
Dialysis blood pressure cuff |
1,154 |
1,045 |
$18K |
| A7013 |
Disposable compressor filter |
7,292 |
5,253 |
$9K |
| A4402 |
Lubricant per ounce |
538 |
423 |
$4K |
| T4530 |
Ped size brief/diaper lg |
35 |
26 |
$4K |
| T4525 |
Adult size pull-on sm |
33 |
30 |
$4K |
| T4522 |
Adult size brief/diaper med |
13 |
12 |
$2K |
| A4239 |
Non-adju cgm supply allow |
26 |
26 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
134 |
89 |
$1K |
| L0626 |
Lo sag rig pnl stays pre cst |
16 |
13 |
$1K |
| A4335 |
Incontinence supply |
327 |
260 |
$383.95 |
| E0602 |
Manual breast pump |
16 |
12 |
$94.17 |