| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
12 |
12 |
$2K |
| A4285 |
Polycarbonate bottle for use with breast pump, replacement |
12 |
12 |
$42.00 |
| A4282 |
Adapter for breast pump, replacement |
12 |
12 |
$0.00 |
| A4283 |
Cap for breast pump bottle, replacement |
12 |
12 |
$0.00 |
| A4284 |
Breast shield and splash protector for use with breast pump, replacement |
12 |
12 |
$0.00 |
| A4286 |
Locking ring for breast pump, replacement |
12 |
12 |
$0.00 |
| A4281 |
Tubing for breast pump, replacement |
12 |
12 |
$0.00 |