| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
4,632 |
2,080 |
$440K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,142 |
1,023 |
$337K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,234 |
2,540 |
$155K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,785 |
1,907 |
$144K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
141 |
102 |
$87K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
102 |
78 |
$82K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,889 |
1,650 |
$79K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,440 |
1,362 |
$68K |
| A7030 |
Full face mask used with positive airway pressure device, each |
537 |
510 |
$37K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
283 |
198 |
$26K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
72 |
71 |
$26K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
95 |
94 |
$10K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
84 |
81 |
$9K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
199 |
194 |
$8K |
| K0040 |
Adjustable angle footplate, each |
95 |
68 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
356 |
343 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
92 |
63 |
$4K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
165 |
156 |
$4K |
| K0001 |
Standard wheelchair |
133 |
130 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
160 |
136 |
$3K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
118 |
84 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
895 |
827 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
83 |
78 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
48 |
46 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
44 |
42 |
$692.65 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
14 |
13 |
$662.60 |
| K0019 |
Arm pad, replacement only, each |
36 |
27 |
$388.83 |