| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
2,359 |
1,634 |
$34K |
| K0001 |
Standard wheelchair |
6,850 |
4,712 |
$28K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,432 |
3,035 |
$22K |
| E0255 |
Hospital bed var ht w/ mattr |
1,847 |
1,182 |
$14K |
| E0630 |
Patient lift hydraulic |
1,426 |
996 |
$7K |
| E0277 |
Powered pres-redu air mattrs |
880 |
627 |
$5K |
| E0973 |
W/ch access det adj armrest |
708 |
448 |
$4K |
| K0195 |
Elevating whlchair leg rests |
2,796 |
1,925 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
273 |
201 |
$2K |
| E0303 |
Hosp bed hvy dty xtra wide |
111 |
73 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
264 |
181 |
$2K |
| K0003 |
Lightweight wheelchair |
427 |
295 |
$1K |
| K0004 |
High strength ltwt whlchr |
367 |
259 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
386 |
286 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
323 |
254 |
$905.12 |
| E0955 |
Cushioned headrest |
195 |
145 |
$651.73 |
| E0978 |
W/c acc,saf belt pelv strap |
255 |
186 |
$624.63 |
| E1028 |
W/c manual swingaway |
328 |
151 |
$555.57 |
| K0739 |
Repair/svc dme non-oxygen eq |
1,158 |
598 |
$540.36 |
| E2365 |
U1 sealed leadacid battery |
118 |
90 |
$538.24 |
| E2601 |
Gen w/c cushion wdth < 22 in |
305 |
226 |
$511.26 |
| E0163 |
Commode chair with fixed arm |
130 |
97 |
$475.45 |
| K0825 |
Pwc gp 2 hd cap chair |
51 |
39 |
$452.81 |
| E0961 |
Wheelchair brake extension |
297 |
226 |
$449.91 |
| E1161 |
Manual adult wc w tiltinspac |
58 |
48 |
$343.39 |
| E1012 |
Ctr mount pwr elev leg rest |
261 |
219 |
$285.70 |
| E0261 |
Hosp bed semi-electr w/o mat |
191 |
162 |
$273.99 |
| E0570 |
Nebulizer with compression |
127 |
77 |
$230.05 |
| E0256 |
Hospital bed var ht w/o matt |
140 |
110 |
$149.86 |
| K0108 |
W/c component-accessory nos |
27 |
13 |
$117.87 |
| E0910 |
Trapeze bar attached to bed |
139 |
108 |
$106.85 |
| E0156 |
Walker seat attachment |
197 |
161 |
$102.79 |
| K0462 |
Temporary replacement eqpmnt |
19 |
13 |
$76.88 |
| E1038 |
Transport chair pt wt<=300lb |
461 |
283 |
$72.30 |
| E0149 |
Heavy duty wheeled walker |
44 |
31 |
$52.95 |
| K0002 |
Stnd hemi (low seat) whlchr |
40 |
37 |
$21.30 |
| K0006 |
Heavy duty wheelchair |
16 |
12 |
$18.87 |
| E0185 |
Gel pressure mattress pad |
53 |
38 |
$0.00 |