433 B
433 B
| 1 | pt id | device_type | service date | quantity | payer | component |
|---|---|---|---|---|---|---|
| 2 | PT-1201 | dexcom g7 | 05/19/2026 | 1 | Blue Cross Blue Shield | sensor |
| 3 | PT-1202 | Dexcom G7 | 05/24/2026 | 6 | Blue Cross Blue Shield | sensor |
| 4 | PT-1203 | dexcom g7 | 05/23/2026 | 9 | Blue Cross Blue Shield | sensor |
| 5 | PT-1204 | Dexcom G7 CGM | 05/27/2026 | 6 | Blue Cross Blue Shield | sensor |
| 6 | PT-1205 | dexcom g7 | 05/30/2026 | 9 | Blue Cross Blue Shield | sensor |
| 7 | PT-1206 | dexcom g7 | 05/23/2026 | 6 | Blue Cross Blue Shield | sensor |