| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
294 |
81 |
$18K |
| K0801 |
Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds |
13 |
13 |
$5K |
| E0272 |
Mattress, foam rubber |
81 |
81 |
$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 |
181 |
174 |
$2K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
110 |
55 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
180 |
154 |
$984.89 |
| K0003 |
Lightweight wheelchair |
123 |
123 |
$980.63 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
65 |
65 |
$860.61 |
| L3710 |
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
158 |
79 |
$812.00 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
70 |
70 |
$703.75 |
| K0069 |
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each |
14 |
14 |
$593.85 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
114 |
57 |
$561.86 |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
13 |
13 |
$503.68 |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
78 |
39 |
$442.84 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
13 |
13 |
$423.09 |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
14 |
14 |
$416.44 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
32 |
32 |
$404.47 |
| E0235 |
Paraffin bath unit, portable (see medical supply code a4265 for paraffin) |
115 |
115 |
$371.59 |
| E0156 |
Seat attachment, walker |
83 |
83 |
$343.62 |
| K0077 |
Front caster assembly, complete, with solid tire, replacement only, each |
14 |
14 |
$320.34 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
39 |
38 |
$218.15 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
14 |
14 |
$138.78 |
| E0982 |
Wheelchair accessory, back upholstery, replacement only, each |
14 |
14 |
$107.35 |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
46 |
46 |
$102.32 |
| E0981 |
Wheelchair accessory, seat upholstery, replacement only, each |
14 |
14 |
$83.97 |
| A4259 |
Lancets, per box of 100 |
180 |
154 |
$77.80 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
43 |
28 |
$37.42 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
43 |
28 |
$30.58 |
| A4256 |
Normal, low and high calibrator solution / chips |
26 |
26 |
$25.31 |
| E0210 |
Electric heat pad, standard |
12 |
12 |
$14.99 |