| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
294 |
81 |
$18K |
| K0801 |
Pov group 1 hd 301-450 lbs |
13 |
13 |
$5K |
| E0272 |
Mattress foam rubber |
81 |
81 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
181 |
174 |
$2K |
| L1902 |
Afo ankle gauntlet pre ots |
110 |
55 |
$2K |
| A4253 |
Blood glucose/reagent strips |
180 |
154 |
$984.89 |
| K0003 |
Lightweight wheelchair |
123 |
123 |
$980.63 |
| E0143 |
Walker folding wheeled w/o s |
65 |
65 |
$860.61 |
| L3710 |
Eo elas w/metal jnts pre ots |
158 |
79 |
$812.00 |
| E0105 |
Cane adjust/fixed quad/3 pro |
70 |
70 |
$703.75 |
| K0069 |
Rr whl compl sol tire rep ea |
14 |
14 |
$593.85 |
| L3908 |
Who cock-up nonmolde pre ots |
114 |
57 |
$561.86 |
| K0462 |
Temporary replacement eqpmnt |
13 |
13 |
$503.68 |
| L1812 |
Ko elastic w/joints pre ots |
78 |
39 |
$442.84 |
| E0973 |
W/ch access det adj armrest |
13 |
13 |
$423.09 |
| K0052 |
Swingaway detach ftrest repl |
14 |
14 |
$416.44 |
| E0163 |
Commode chair with fixed arm |
32 |
32 |
$404.47 |
| E0235 |
Paraffin bath unit portable |
115 |
115 |
$371.59 |
| E0156 |
Walker seat attachment |
83 |
83 |
$343.62 |
| K0077 |
Fr cstr asmb sol tire rep ea |
14 |
14 |
$320.34 |
| E0978 |
W/c acc,saf belt pelv strap |
39 |
38 |
$218.15 |
| E0961 |
Wheelchair brake extension |
14 |
14 |
$138.78 |
| E0982 |
Back upholstery, replacement |
14 |
14 |
$107.35 |
| L0642 |
Lo sag ri an/pos pnl pre ots |
46 |
46 |
$102.32 |
| E0981 |
Seat upholstery, replacement |
14 |
14 |
$83.97 |
| A4259 |
Lancets per box |
180 |
154 |
$77.80 |
| A5512 |
Multi den insert direct form |
43 |
28 |
$37.42 |
| A5500 |
Diab shoe for density insert |
43 |
28 |
$30.58 |
| A4256 |
Calibrator solution/chips |
26 |
26 |
$25.31 |
| E0210 |
Electric heat pad standard |
12 |
12 |
$14.99 |