| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
45,917 |
45,006 |
$7.07M |
| E0570 |
Nebulizer with compression |
38,215 |
37,626 |
$3.21M |
| A4287 |
Disp col sto bag breast milk |
11,222 |
11,011 |
$872K |
| K1005 |
Disp col sto bag breast milk |
18,804 |
18,147 |
$828K |
| A7005 |
Nondisposable nebulizer set |
23,489 |
23,306 |
$467K |
| S9999 |
Sales tax |
18,653 |
17,861 |
$173K |
| A4670 |
Automatic bp monitor, dial |
1,828 |
1,796 |
$96K |
| A6530 |
Compression stocking bk18-30 |
1,047 |
1,008 |
$93K |
| L0621 |
Sio flex pelvic/sacr pre ots |
518 |
511 |
$26K |
| A7015 |
Aerosol mask used w nebulize |
17,592 |
17,488 |
$25K |
| A4281 |
Replacement breastpump tube |
1,205 |
1,134 |
$20K |
| A4284 |
Replcmnt breast pump shield |
1,206 |
1,123 |
$16K |
| A9901 |
Delivery/set up/dispensing |
5,050 |
4,897 |
$13K |
| A4285 |
Replcmnt breast pump bottle |
1,216 |
1,143 |
$10K |
| A4627 |
Spacer bag/reservoir |
684 |
683 |
$8K |
| A4283 |
Replacement breastpump cap |
1,010 |
958 |
$8K |
| S8101 |
Spacer with mask |
365 |
363 |
$8K |
| A4286 |
Replcmnt breastpump lok ring |
538 |
501 |
$2K |
| A9999 |
Dme supply or accessory, nos |
73 |
73 |
$730.05 |
| S8100 |
Spacer without mask |
12 |
12 |
$228.00 |
| 00000 |
|
25 |
25 |
$0.00 |