| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
2,543 |
1,968 |
$184K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,154 |
2,627 |
$142K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,863 |
2,698 |
$135K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,539 |
5,017 |
$101K |
| K0003 |
Lightweight wheelchair |
3,949 |
2,969 |
$55K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,064 |
1,451 |
$30K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,159 |
1,054 |
$29K |
| K0001 |
Standard wheelchair |
2,416 |
1,893 |
$24K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
296 |
232 |
$23K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,020 |
570 |
$18K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
180 |
172 |
$12K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,246 |
2,177 |
$12K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,118 |
760 |
$11K |
| K0002 |
Standard hemi (low seat) wheelchair |
633 |
461 |
$8K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
21 |
12 |
$7K |
| E0570 |
Nebulizer, with compressor |
705 |
512 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
729 |
324 |
$7K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
132 |
98 |
$5K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
35 |
29 |
$5K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
186 |
137 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
572 |
247 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
396 |
313 |
$3K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
830 |
694 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
604 |
261 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
203 |
158 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
146 |
106 |
$2K |
| K0006 |
Heavy duty wheelchair |
60 |
52 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
558 |
385 |
$2K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
24 |
15 |
$2K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
61 |
49 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
95 |
43 |
$758.30 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
713 |
465 |
$746.45 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
43 |
40 |
$52.22 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$0.00 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$0.00 |