| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
818 |
818 |
$13K |
| K0005 |
Ultralightweight wheelchair |
63 |
62 |
$13K |
| K0003 |
Lightweight wheelchair |
747 |
747 |
$8K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
122 |
121 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
279 |
142 |
$2K |
| K0001 |
Standard wheelchair |
163 |
162 |
$850.94 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
231 |
116 |
$687.42 |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
188 |
188 |
$582.96 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
203 |
200 |
$550.64 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
138 |
137 |
$479.33 |
| E0184 |
Dry pressure mattress |
25 |
25 |
$442.51 |
| E2218 |
Manual wheelchair accessory, foam propulsion tire, any size, each |
90 |
44 |
$431.44 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
152 |
76 |
$313.16 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
95 |
56 |
$284.72 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
32 |
16 |
$197.12 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$180.69 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
76 |
75 |
$140.46 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$41.70 |