| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Pneuma/vac walk boot pre ots |
1,405 |
1,374 |
$312K |
| L3670 |
So acro/clav can web pre ots |
3,554 |
3,477 |
$249K |
| E0603 |
Electric breast pump |
3,762 |
3,695 |
$231K |
| E0114 |
Crutch underarm pair no wood |
3,128 |
3,068 |
$120K |
| L3809 |
Whfo w/o joints pre ots |
637 |
624 |
$95K |
| L3908 |
Who cock-up nonmolde pre ots |
1,494 |
1,402 |
$80K |
| L4360 |
Pneumat walking boot pre cst |
269 |
266 |
$65K |
| L1820 |
Ko elas w/ condyle pads & jo |
461 |
454 |
$47K |
| L4350 |
Ankle control ortho pre ots |
535 |
524 |
$35K |
| L1830 |
Ko immob canvas long pre ots |
526 |
519 |
$35K |
| E0604 |
Hosp grade elec breast pump |
540 |
523 |
$24K |
| L3807 |
Whfo w/o joints pre cst |
109 |
108 |
$17K |
| E0784 |
Ext amb infusn pump insulin |
24 |
13 |
$10K |
| E0143 |
Walker folding wheeled w/o s |
149 |
146 |
$10K |
| A4230 |
Infus insulin pump non needl |
28 |
28 |
$8K |
| L1902 |
Afo ankle gauntlet pre ots |
106 |
104 |
$7K |
| L0172 |
Cerv col sr foam 2pc pre ots |
54 |
52 |
$5K |
| A4232 |
Syringe w/needle insulin 3cc |
28 |
28 |
$3K |
| S9999 |
Sales tax |
13 |
12 |
$0.00 |