| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
145 |
145 |
$17K |
| E0604 |
Hosp grade elec breast pump |
169 |
169 |
$12K |
| E0570 |
Nebulizer with compression |
185 |
185 |
$11K |
| L0625 |
Lo flex l1-below l5 pre ots |
204 |
203 |
$9K |
| A6530 |
Compression stocking bk18-30 |
73 |
72 |
$7K |
| T4527 |
Adult size pull-on lg |
20 |
20 |
$3K |
| T4541 |
Large disposable underpad |
19 |
19 |
$1K |
| E0605 |
Vaporizer room type |
50 |
50 |
$1K |
| A7005 |
Nondisposable nebulizer set |
45 |
45 |
$1K |
| B4150 |
Ef complet w/intact nutrient |
12 |
12 |
$1K |
| A4595 |
Tens suppl 2 lead per month |
25 |
25 |
$706.93 |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$700.82 |
| A4927 |
Non-sterile gloves |
20 |
20 |
$559.55 |
| T4535 |
Disposable liner/shield/pad |
19 |
19 |
$405.81 |
| A7015 |
Aerosol mask used w nebulize |
63 |
62 |
$86.75 |
| A7013 |
Disposable compressor filter |
98 |
97 |
$76.30 |