| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,054 |
2,048 |
$342K |
| A4554 |
Disposable underpads, all sizes |
2,193 |
2,186 |
$101K |
| E0570 |
Nebulizer, with compressor |
560 |
550 |
$51K |
| A4284 |
Breast shield and splash protector for use with breast pump, replacement |
2,443 |
2,442 |
$44K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
281 |
280 |
$42K |
| A4281 |
Tubing for breast pump, replacement |
2,443 |
2,442 |
$22K |
| A4335 |
Incontinence supply; miscellaneous |
2,917 |
2,900 |
$17K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
389 |
388 |
$17K |
| A4285 |
Polycarbonate bottle for use with breast pump, replacement |
2,443 |
2,442 |
$14K |
| A4283 |
Cap for breast pump bottle, replacement |
2,443 |
2,442 |
$3K |
| A4282 |
Adapter for breast pump, replacement |
2,443 |
2,442 |
$3K |
| A4286 |
Locking ring for breast pump, replacement |
2,443 |
2,442 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
479 |
466 |
$2K |
| K0001 |
Standard wheelchair |
26 |
25 |
$843.02 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
25 |
24 |
$298.39 |