| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0650 |
Lso sc r ant/pos pnl pre ots |
550 |
545 |
$11K |
| L1832 |
Ko adj jnt pos r sup pre cst |
690 |
563 |
$8K |
| A4595 |
Tens suppl 2 lead per month |
7,709 |
7,477 |
$6K |
| A4239 |
Non-adju cgm supply allow |
667 |
658 |
$6K |
| K0004 |
High strength ltwt whlchr |
67 |
65 |
$4K |
| L3915 |
Who nontorsion jnts pre cst |
225 |
153 |
$4K |
| L2810 |
Knee control condylar pad |
707 |
584 |
$2K |
| L3908 |
Who cock-up nonmolde pre ots |
327 |
235 |
$1K |
| L2795 |
Knee control full kneecap |
676 |
553 |
$1K |
| L2397 |
Suspension sleeve lower ext |
729 |
598 |
$996.92 |
| E0730 |
Tens four lead |
653 |
604 |
$684.44 |
| E2611 |
Gen use back cush wdth <22in |
51 |
51 |
$669.96 |
| E0990 |
Wheelchair elevating leg res |
52 |
52 |
$542.10 |
| E0973 |
W/ch access det adj armrest |
52 |
52 |
$462.60 |
| K0001 |
Standard wheelchair |
78 |
75 |
$190.66 |
| E0971 |
Wheelchair anti-tipping devi |
40 |
40 |
$163.88 |
| E2601 |
Gen w/c cushion wdth < 22 in |
51 |
51 |
$152.38 |
| E0961 |
Wheelchair brake extension |
52 |
52 |
$144.66 |
| E0951 |
Loop heel |
53 |
53 |
$101.48 |
| E0978 |
W/c acc,saf belt pelv strap |
53 |
53 |
$92.56 |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$0.00 |
| K0553 |
Ther cgm supply allowance |
112 |
110 |
$0.00 |