| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
5,368 |
2,010 |
$491K |
| E1161 |
Manual adult wc w tiltinspac |
1,101 |
999 |
$185K |
| E0601 |
Cont airway pressure device |
3,598 |
3,346 |
$177K |
| E1028 |
W/c manual swingaway |
3,374 |
2,028 |
$174K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,932 |
2,333 |
$140K |
| E1390 |
Oxygen concentrator |
3,151 |
2,931 |
$137K |
| A7030 |
Cpap full face mask |
2,032 |
1,845 |
$110K |
| E0955 |
Cushioned headrest |
1,783 |
1,586 |
$59K |
| E0470 |
Rad w/o backup non-inv intfc |
367 |
344 |
$39K |
| A7035 |
Pos airway press headgear |
1,953 |
1,761 |
$30K |
| K0001 |
Standard wheelchair |
1,092 |
1,025 |
$26K |
| A4604 |
Tubing with heating element |
1,672 |
1,486 |
$26K |
| E0562 |
Humidifier heated used w pap |
276 |
239 |
$25K |
| E0431 |
Portable gaseous 02 |
1,736 |
1,592 |
$22K |
| A7031 |
Replacement facemask interfa |
1,217 |
1,063 |
$22K |
| E0973 |
W/ch access det adj armrest |
267 |
169 |
$18K |
| E0260 |
Hosp bed semi-electr w/ matt |
243 |
225 |
$11K |
| A7034 |
Nasal application device |
407 |
351 |
$10K |
| T4527 |
Adult size pull-on lg |
82 |
79 |
$9K |
| A7038 |
Pos airway pressure filter |
3,474 |
3,036 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
367 |
291 |
$7K |
| A7037 |
Pos airway pressure tubing |
460 |
413 |
$7K |
| A7032 |
Replacement nasal cushion |
283 |
234 |
$5K |
| E0960 |
W/c shoulder harness/straps |
104 |
74 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
130 |
91 |
$4K |
| T4542 |
Small disposable underpad |
92 |
88 |
$4K |
| K0040 |
Adjustable angle footplate |
53 |
42 |
$3K |
| K0070 |
Rr whl compl pne tire rep ea |
26 |
26 |
$2K |
| E0570 |
Nebulizer with compression |
106 |
90 |
$1K |
| E2213 |
Pneumatic prop tire insert |
29 |
25 |
$982.21 |
| E0950 |
Tray |
15 |
13 |
$829.72 |
| E2211 |
Pneumatic propulsion tire |
19 |
15 |
$707.10 |
| A4927 |
Non-sterile gloves |
44 |
43 |
$590.92 |
| K0823 |
Pwc gp 2 std cap chair |
12 |
12 |
$569.91 |
| E0961 |
Wheelchair brake extension |
16 |
14 |
$378.51 |
| E0951 |
Loop heel |
19 |
12 |
$300.70 |
| A7046 |
Repl water chamber, pap dev |
70 |
61 |
$154.53 |
| A7039 |
Filter, non disposable w pap |
13 |
13 |
$100.89 |