| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1223 |
Wheelchair spec size w foot |
6,655 |
5,059 |
$204K |
| E0260 |
Hosp bed semi-electr w/ matt |
9,745 |
7,003 |
$187K |
| K0823 |
Pwc gp 2 std cap chair |
1,169 |
858 |
$47K |
| K0003 |
Lightweight wheelchair |
4,907 |
3,861 |
$37K |
| E0630 |
Patient lift hydraulic |
2,141 |
1,580 |
$35K |
| E2611 |
Gen use back cush wdth <22in |
1,319 |
843 |
$26K |
| E0973 |
W/ch access det adj armrest |
3,555 |
1,316 |
$26K |
| K0001 |
Standard wheelchair |
6,179 |
5,059 |
$22K |
| E0143 |
Walker folding wheeled w/o s |
1,867 |
1,391 |
$21K |
| E0570 |
Nebulizer with compression |
2,306 |
1,727 |
$14K |
| E0185 |
Gel pressure mattress pad |
571 |
390 |
$12K |
| E0149 |
Heavy duty wheeled walker |
2,099 |
1,580 |
$12K |
| E0245 |
Tub stool or bench |
519 |
447 |
$11K |
| E2601 |
Gen w/c cushion wdth < 22 in |
1,415 |
974 |
$11K |
| K0007 |
Extra heavy duty wheelchair |
396 |
336 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
2,201 |
823 |
$8K |
| E0163 |
Commode chair with fixed arm |
390 |
283 |
$4K |
| E0156 |
Walker seat attachment |
966 |
735 |
$4K |
| E1240 |
Whchr litwt det arm leg rest |
415 |
328 |
$3K |
| E1280 |
Whchr h-duty det arm leg res |
14 |
13 |
$2K |
| E1031 |
Rollabout chair with casters |
137 |
122 |
$1K |
| E1028 |
W/c manual swingaway |
754 |
561 |
$1K |
| E1038 |
Transport chair pt wt<=300lb |
218 |
186 |
$1K |
| E0627 |
Seat lift mech, electric any |
18 |
14 |
$452.90 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
63 |
41 |
$383.75 |
| A4670 |
Automatic bp monitor, dial |
14 |
14 |
$367.45 |
| K0006 |
Heavy duty wheelchair |
212 |
133 |
$267.85 |
| A6216 |
Non-sterile gauze<=16 sq in |
112 |
86 |
$139.28 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
14 |
12 |
$130.24 |
| A6446 |
Conform band s w>=3" <5"/yd |
34 |
26 |
$99.18 |
| A4450 |
Non-waterproof tape |
87 |
64 |
$43.02 |
| E0910 |
Trapeze bar attached to bed |
16 |
12 |
$11.47 |
| E0240 |
Bath/shower chair |
32 |
15 |
$0.00 |