| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0003 |
Lightweight wheelchair |
2,584 |
2,545 |
$17K |
| A4554 |
Disposable underpads, all sizes |
220 |
216 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,137 |
3,074 |
$6K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
767 |
764 |
$4K |
| K0001 |
Standard wheelchair |
403 |
396 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
114 |
76 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
253 |
250 |
$1K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
252 |
248 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
37 |
37 |
$474.83 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
21 |
21 |
$223.50 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
19 |
19 |
$122.69 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
21 |
21 |
$83.76 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
19 |
19 |
$0.00 |