| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
145 |
145 |
$17K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
169 |
169 |
$12K |
| E0570 |
Nebulizer, with compressor |
185 |
185 |
$11K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
204 |
203 |
$9K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
73 |
72 |
$7K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
20 |
20 |
$3K |
| T4541 |
Incontinence product, disposable underpad, large, each |
19 |
19 |
$1K |
| E0605 |
Vaporizer, room type |
50 |
50 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
45 |
45 |
$1K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12 |
12 |
$1K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
25 |
25 |
$706.93 |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$700.82 |
| A4927 |
Gloves, non-sterile, per 100 |
20 |
20 |
$559.55 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
19 |
19 |
$405.81 |
| A7015 |
Aerosol mask, used with dme nebulizer |
63 |
62 |
$86.75 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
98 |
97 |
$76.30 |