| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
4,311 |
4,079 |
$141K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,120 |
445 |
$102K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,797 |
2,437 |
$101K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
1,175 |
1,118 |
$67K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,517 |
1,400 |
$66K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
761 |
706 |
$56K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
707 |
309 |
$31K |
| L3260 |
Surgical boot/shoe, each |
1,388 |
1,261 |
$25K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,000 |
812 |
$20K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
275 |
76 |
$20K |
| K0001 |
Standard wheelchair |
1,010 |
862 |
$20K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
441 |
390 |
$17K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
356 |
319 |
$14K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
133 |
83 |
$11K |
| E0245 |
Tub stool or bench |
178 |
165 |
$9K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
685 |
642 |
$8K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
153 |
130 |
$8K |
| E0156 |
Seat attachment, walker |
585 |
548 |
$7K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
50 |
49 |
$6K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
205 |
167 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
141 |
111 |
$5K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
161 |
138 |
$4K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
134 |
60 |
$3K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
29 |
12 |
$2K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
14 |
12 |
$1K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
13 |
13 |
$726.10 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
18 |
13 |
$499.77 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
16 |
15 |
$437.55 |
| E0244 |
Raised toilet seat |
15 |
13 |
$354.96 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
13 |
13 |
$335.82 |