| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,649 |
1,553 |
$19K |
| K0001 |
Standard wheelchair |
2,040 |
1,905 |
$9K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
294 |
237 |
$9K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
231 |
206 |
$8K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
499 |
451 |
$8K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
753 |
712 |
$8K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
195 |
169 |
$5K |
| K0003 |
Lightweight wheelchair |
738 |
667 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
379 |
345 |
$4K |
| E0277 |
Powered pressure-reducing air mattress |
127 |
109 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
924 |
849 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
69 |
54 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
157 |
135 |
$1K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12 |
12 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
68 |
65 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
89 |
74 |
$817.82 |
| E0776 |
Iv pole |
602 |
594 |
$627.64 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
85 |
67 |
$580.19 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
78 |
63 |
$531.53 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
70 |
53 |
$347.09 |
| E0184 |
Dry pressure mattress |
16 |
12 |
$302.62 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
22 |
20 |
$182.42 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
42 |
41 |
$130.69 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
63 |
50 |
$92.92 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
83 |
66 |
$11.39 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
13 |
12 |
$6.57 |