| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
3,547 |
2,136 |
$419K |
| K0003 |
Lightweight wheelchair |
14,558 |
9,665 |
$346K |
| E0143 |
Walker folding wheeled w/o s |
5,824 |
4,152 |
$244K |
| E0260 |
Hosp bed semi-electr w/ matt |
7,200 |
4,481 |
$171K |
| K0001 |
Standard wheelchair |
7,617 |
5,559 |
$99K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
592 |
413 |
$93K |
| K0195 |
Elevating whlchair leg rests |
5,075 |
2,937 |
$92K |
| A4624 |
Tracheal suction tube |
1,347 |
767 |
$85K |
| E0163 |
Commode chair with fixed arm |
3,548 |
2,461 |
$83K |
| E0570 |
Nebulizer with compression |
1,949 |
1,427 |
$55K |
| E0630 |
Patient lift hydraulic |
2,372 |
1,510 |
$53K |
| A4623 |
Tracheostomy inner cannula |
1,001 |
548 |
$52K |
| A4629 |
Tracheostomy care kit |
1,126 |
514 |
$44K |
| E2611 |
Gen use back cush wdth <22in |
912 |
566 |
$43K |
| K0006 |
Heavy duty wheelchair |
1,771 |
1,093 |
$39K |
| E2601 |
Gen w/c cushion wdth < 22 in |
2,101 |
1,283 |
$34K |
| E1236 |
Folding ped wc adjustable |
464 |
345 |
$34K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
470 |
263 |
$30K |
| A7000 |
Disposable canister for pump |
2,209 |
1,289 |
$24K |
| K0007 |
Extra heavy duty wheelchair |
800 |
440 |
$23K |
| E0261 |
Hosp bed semi-electr w/o mat |
364 |
295 |
$23K |
| A7526 |
Tracheostomy tube collar |
1,087 |
617 |
$20K |
| E0600 |
Suction pump portab hom modl |
2,271 |
1,419 |
$19K |
| E1060 |
Wheelchair detachable arms |
295 |
216 |
$15K |
| A7005 |
Nondisposable nebulizer set |
1,196 |
957 |
$15K |
| E1150 |
Wheelchair standard w/ leg r |
531 |
465 |
$14K |
| A7002 |
Tubing used w suction pump |
2,111 |
1,274 |
$12K |
| T4522 |
Adult size brief/diaper med |
325 |
97 |
$12K |
| A4628 |
Oropharyngeal suction cath |
1,856 |
1,106 |
$11K |
| E1140 |
Wheelchair standard detach a |
415 |
352 |
$10K |
| E0165 |
Commode chair with detacharm |
694 |
432 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
1,414 |
697 |
$8K |
| E0951 |
Loop heel |
8,671 |
3,028 |
$7K |
| E1226 |
Manual fully reclining back |
155 |
65 |
$6K |
| E0149 |
Heavy duty wheeled walker |
1,198 |
639 |
$6K |
| E0156 |
Walker seat attachment |
1,125 |
643 |
$6K |
| T4527 |
Adult size pull-on lg |
56 |
24 |
$5K |
| A4930 |
Sterile, gloves per pair |
257 |
141 |
$4K |
| A5500 |
Diab shoe for density insert |
47 |
37 |
$3K |
| E0168 |
Heavyduty/wide commode chair |
137 |
81 |
$2K |
| A5512 |
Multi den insert direct form |
47 |
37 |
$1K |
| E0272 |
Mattress foam rubber |
43 |
30 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
1,201 |
957 |
$1K |
| E0910 |
Trapeze bar attached to bed |
383 |
183 |
$743.78 |
| E0105 |
Cane adjust/fixed quad/3 pro |
13 |
12 |
$332.88 |
| E1225 |
Manual semi-reclining back |
15 |
12 |
$325.58 |
| E0305 |
Rails bed side half length |
166 |
126 |
$150.16 |
| E0978 |
W/c acc,saf belt pelv strap |
113 |
93 |
$87.56 |