| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,701 |
1,476 |
$191K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
2,092 |
1,993 |
$64K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
615 |
610 |
$57K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
232 |
218 |
$30K |
| E0935 |
Continuous passive motion exercise device for use on knee only |
655 |
104 |
$6K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
40 |
27 |
$6K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$5K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
40 |
40 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
143 |
138 |
$3K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
42 |
41 |
$1K |