| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Whlchr special size/constrc |
731 |
571 |
$4.71M |
| K0108 |
W/c component-accessory nos |
2,131 |
1,225 |
$2.59M |
| E1399 |
Durable medical equipment mi |
591 |
428 |
$1.91M |
| E0240 |
Bath/shower chair |
334 |
251 |
$495K |
| K0005 |
Ultralightweight wheelchair |
191 |
163 |
$256K |
| E1161 |
Manual adult wc w tiltinspac |
885 |
598 |
$87K |
| E0601 |
Cont airway pressure device |
1,900 |
1,618 |
$80K |
| E0973 |
W/ch access det adj armrest |
675 |
497 |
$60K |
| E2607 |
Skin pro/pos wc cus wd <22in |
323 |
257 |
$50K |
| E2620 |
Wc planar back cush wd <22in |
156 |
129 |
$35K |
| K0040 |
Adjustable angle footplate |
400 |
307 |
$34K |
| E0971 |
Wheelchair anti-tipping devi |
478 |
351 |
$24K |
| E1028 |
W/c manual swingaway |
1,388 |
689 |
$21K |
| E0265 |
Hosp bed total electr w/ mat |
13 |
12 |
$14K |
| A7034 |
Nasal application device |
213 |
193 |
$12K |
| E0955 |
Cushioned headrest |
844 |
595 |
$7K |
| A7037 |
Pos airway pressure tubing |
422 |
369 |
$7K |
| A7035 |
Pos airway press headgear |
396 |
346 |
$7K |
| E0562 |
Humidifier heated used w pap |
148 |
127 |
$6K |
| A7032 |
Replacement nasal cushion |
248 |
215 |
$5K |
| E0630 |
Patient lift hydraulic |
32 |
24 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
178 |
138 |
$4K |
| E2213 |
Pneumatic prop tire insert |
71 |
56 |
$3K |
| E2211 |
Pneumatic propulsion tire |
54 |
38 |
$2K |
| E2219 |
Foam caster tire any size ea |
30 |
26 |
$2K |
| A7038 |
Pos airway pressure filter |
676 |
395 |
$2K |
| E0951 |
Loop heel |
70 |
55 |
$1K |
| E2363 |
Gr24 sealed leadacid battery |
19 |
12 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
236 |
183 |
$897.87 |
| E2377 |
Expandable controller, initl |
14 |
12 |
$355.36 |
| A7039 |
Filter, non disposable w pap |
43 |
38 |
$219.22 |
| E2313 |
Pwc harness, expand control |
14 |
12 |
$144.28 |
| E1012 |
Ctr mount pwr elev leg rest |
15 |
13 |
$0.00 |