| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6531 |
Compress stking bk30-40 surg |
54 |
27 |
$2K |
| L0648 |
Lso sag r an/pos pnl pre ots |
13 |
13 |
$2K |
| A4670 |
Automatic bp monitor, dial |
70 |
69 |
$1K |
| E0570 |
Nebulizer with compression |
113 |
111 |
$1K |
| A7010 |
Disposable corrugated tubing |
112 |
110 |
$1K |
| L3030 |
Foot arch support remov prem |
60 |
29 |
$1K |
| A4554 |
Disposable underpads |
30 |
28 |
$248.00 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$196.07 |
| L3221 |
Orthopedic mens shoes dpth i |
24 |
12 |
$194.72 |
| L3807 |
Whfo w/o joints pre cst |
18 |
12 |
$144.99 |
| A7015 |
Aerosol mask used w nebulize |
112 |
110 |
$93.16 |