| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0260 |
Hosp bed semi-electr w/ matt |
4,461 |
3,869 |
$118K |
| K0001 |
Standard wheelchair |
10,238 |
9,079 |
$105K |
| A4520 |
Incontinence garment anytype |
448 |
316 |
$91K |
| E0630 |
Patient lift hydraulic |
1,291 |
1,142 |
$46K |
| K0195 |
Elevating whlchair leg rests |
9,765 |
8,580 |
$41K |
| E1390 |
Oxygen concentrator |
741 |
654 |
$35K |
| K0003 |
Lightweight wheelchair |
1,666 |
1,504 |
$31K |
| E0143 |
Walker folding wheeled w/o s |
645 |
557 |
$18K |
| E2611 |
Gen use back cush wdth <22in |
316 |
278 |
$16K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,843 |
1,574 |
$15K |
| E2601 |
Gen w/c cushion wdth < 22 in |
871 |
757 |
$11K |
| E0973 |
W/ch access det adj armrest |
1,130 |
983 |
$11K |
| E0163 |
Commode chair with fixed arm |
642 |
553 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
2,411 |
2,173 |
$8K |
| K0007 |
Extra heavy duty wheelchair |
174 |
153 |
$6K |
| E0431 |
Portable gaseous 02 |
384 |
341 |
$4K |
| K0006 |
Heavy duty wheelchair |
132 |
105 |
$3K |
| T4527 |
Adult size pull-on lg |
42 |
42 |
$3K |
| K0002 |
Stnd hemi (low seat) whlchr |
191 |
178 |
$2K |
| E1038 |
Transport chair pt wt<=300lb |
359 |
326 |
$2K |
| A4554 |
Disposable underpads |
126 |
105 |
$2K |
| E0961 |
Wheelchair brake extension |
545 |
474 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
12 |
12 |
$1K |
| E0240 |
Bath/shower chair |
13 |
13 |
$691.25 |
| E0978 |
W/c acc,saf belt pelv strap |
159 |
145 |
$615.01 |
| E1225 |
Manual semi-reclining back |
41 |
36 |
$393.18 |
| K0052 |
Swingaway detach ftrest repl |
1,234 |
1,138 |
$310.73 |
| E0621 |
Patient lift sling or seat |
78 |
78 |
$31.22 |