| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
2,543 |
1,968 |
$184K |
| E1390 |
Oxygen concentrator |
3,154 |
2,627 |
$142K |
| E0601 |
Cont airway pressure device |
2,863 |
2,698 |
$135K |
| E0260 |
Hosp bed semi-electr w/ matt |
7,539 |
5,017 |
$101K |
| K0003 |
Lightweight wheelchair |
3,949 |
2,969 |
$55K |
| E0630 |
Patient lift hydraulic |
2,064 |
1,451 |
$30K |
| E0431 |
Portable gaseous 02 |
1,159 |
1,054 |
$29K |
| K0001 |
Standard wheelchair |
2,416 |
1,893 |
$24K |
| E2611 |
Gen use back cush wdth <22in |
296 |
232 |
$23K |
| E1028 |
W/c manual swingaway |
1,020 |
570 |
$18K |
| E0255 |
Hospital bed var ht w/ mattr |
180 |
172 |
$12K |
| E0562 |
Humidifier heated used w pap |
2,246 |
2,177 |
$12K |
| E0955 |
Cushioned headrest |
1,118 |
760 |
$11K |
| K0002 |
Stnd hemi (low seat) whlchr |
633 |
461 |
$8K |
| E2311 |
Electro connect btw 2 sys |
21 |
12 |
$7K |
| E0570 |
Nebulizer with compression |
705 |
512 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
729 |
324 |
$7K |
| E2361 |
22nf sealed leadacid battery |
132 |
98 |
$5K |
| K0800 |
Pov group 1 std up to 300lbs |
35 |
29 |
$5K |
| E0185 |
Gel pressure mattress pad |
186 |
137 |
$4K |
| E0961 |
Wheelchair brake extension |
572 |
247 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
396 |
313 |
$3K |
| K0738 |
Portable gas oxygen system |
830 |
694 |
$3K |
| E0951 |
Loop heel |
604 |
261 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
203 |
158 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
146 |
106 |
$2K |
| K0006 |
Heavy duty wheelchair |
60 |
52 |
$2K |
| K0195 |
Elevating whlchair leg rests |
558 |
385 |
$2K |
| E2624 |
Adj skin pro/pos cus<22in |
24 |
15 |
$2K |
| E2365 |
U1 sealed leadacid battery |
61 |
49 |
$1K |
| E0973 |
W/ch access det adj armrest |
95 |
43 |
$758.30 |
| E0181 |
Press pad alternating w/ pum |
713 |
465 |
$746.45 |
| A7038 |
Pos airway pressure filter |
43 |
40 |
$52.22 |
| A7035 |
Pos airway press headgear |
12 |
12 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$0.00 |