| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Pneumat walking boot pre cst |
250 |
246 |
$27K |
| A6530 |
Compression stocking bk18-30 |
260 |
205 |
$14K |
| L3670 |
So acro/clav can web pre ots |
410 |
397 |
$12K |
| E0603 |
Electric breast pump |
218 |
218 |
$11K |
| E0114 |
Crutch underarm pair no wood |
456 |
449 |
$8K |
| E0143 |
Walker folding wheeled w/o s |
163 |
161 |
$6K |
| L3908 |
Who cock-up nonmolde pre ots |
127 |
118 |
$3K |
| L0621 |
Sio flex pelvic/sacr pre ots |
33 |
33 |
$589.52 |
| L3260 |
Ambulatory surgical boot eac |
16 |
16 |
$455.00 |
| A9900 |
Supply/accessory/service |
231 |
226 |
$0.00 |