| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
3,542 |
3,458 |
$460K |
| E0260 |
Hosp bed semi-electr w/ matt |
8,895 |
8,619 |
$268K |
| K0003 |
Lightweight wheelchair |
6,809 |
6,498 |
$199K |
| K0002 |
Stnd hemi (low seat) whlchr |
9,368 |
8,990 |
$179K |
| E2611 |
Gen use back cush wdth <22in |
1,661 |
1,478 |
$160K |
| E1390 |
Oxygen concentrator |
2,465 |
2,316 |
$111K |
| E0630 |
Patient lift hydraulic |
2,068 |
2,018 |
$65K |
| E0971 |
Wheelchair anti-tipping devi |
2,879 |
1,719 |
$62K |
| E0973 |
W/ch access det adj armrest |
1,083 |
645 |
$55K |
| E0143 |
Walker folding wheeled w/o s |
1,080 |
1,026 |
$45K |
| E2601 |
Gen w/c cushion wdth < 22 in |
1,472 |
1,306 |
$43K |
| K0004 |
High strength ltwt whlchr |
659 |
621 |
$37K |
| E0185 |
Gel pressure mattress pad |
723 |
702 |
$35K |
| E0961 |
Wheelchair brake extension |
2,721 |
1,515 |
$33K |
| K0195 |
Elevating whlchair leg rests |
13,682 |
13,399 |
$32K |
| K0006 |
Heavy duty wheelchair |
579 |
549 |
$27K |
| K0738 |
Portable gas oxygen system |
1,900 |
1,772 |
$27K |
| K0007 |
Extra heavy duty wheelchair |
346 |
291 |
$26K |
| E0978 |
W/c acc,saf belt pelv strap |
1,785 |
1,561 |
$25K |
| E0163 |
Commode chair with fixed arm |
612 |
600 |
$25K |
| E0240 |
Bath/shower chair |
270 |
237 |
$22K |
| K0825 |
Pwc gp 2 hd cap chair |
77 |
75 |
$19K |
| E0955 |
Cushioned headrest |
452 |
404 |
$15K |
| E0990 |
Wheelchair elevating leg res |
94 |
87 |
$13K |
| E1028 |
W/c manual swingaway |
124 |
102 |
$11K |
| E2365 |
U1 sealed leadacid battery |
155 |
129 |
$8K |
| K0739 |
Repair/svc dme non-oxygen eq |
713 |
638 |
$8K |
| E2361 |
22nf sealed leadacid battery |
62 |
50 |
$7K |
| E0247 |
Trans bench w/wo comm open |
27 |
27 |
$3K |
| E0156 |
Walker seat attachment |
235 |
218 |
$2K |
| E0303 |
Hosp bed hvy dty xtra wide |
25 |
24 |
$2K |
| E0149 |
Heavy duty wheeled walker |
68 |
63 |
$2K |
| E0294 |
Hosp bed semi-elect w/ mattr |
66 |
66 |
$769.92 |
| K0108 |
W/c component-accessory nos |
23 |
15 |
$586.27 |