| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,566 |
3,077 |
$157K |
| K0003 |
Lightweight wheelchair |
3,869 |
3,502 |
$56K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,157 |
1,980 |
$53K |
| E0601 |
Cont airway pressure device |
1,061 |
911 |
$48K |
| E0570 |
Nebulizer with compression |
1,088 |
957 |
$25K |
| K0195 |
Elevating whlchair leg rests |
1,141 |
1,015 |
$20K |
| E0431 |
Portable gaseous 02 |
2,810 |
2,377 |
$11K |
| A5500 |
Diab shoe for density insert |
246 |
115 |
$10K |
| E0165 |
Commode chair with detacharm |
352 |
328 |
$5K |
| A5512 |
Multi den insert direct form |
230 |
113 |
$4K |
| E2611 |
Gen use back cush wdth <22in |
38 |
31 |
$3K |
| K0006 |
Heavy duty wheelchair |
133 |
120 |
$3K |
| K0001 |
Standard wheelchair |
164 |
148 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
51 |
39 |
$1K |
| E0630 |
Patient lift hydraulic |
25 |
25 |
$1K |
| E0163 |
Commode chair with fixed arm |
14 |
13 |
$291.36 |