| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
857 |
755 |
$139K |
| E0570 |
Nebulizer, with compressor |
1,376 |
1,263 |
$91K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
330 |
304 |
$20K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
558 |
518 |
$3K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
34 |
24 |
$910.73 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
21 |
12 |
$473.05 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
14 |
14 |
$38.27 |
| 0013A |
|
29 |
28 |
$0.00 |
| 0064A |
|
14 |
14 |
$0.00 |
| 0012A |
|
69 |
68 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
13 |
12 |
$0.00 |
| 0011A |
|
69 |
68 |
$0.00 |