| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0260 |
Hosp bed semi-electr w/ matt |
4,923 |
3,862 |
$31K |
| K0823 |
Pwc gp 2 std cap chair |
593 |
413 |
$29K |
| K0002 |
Stnd hemi (low seat) whlchr |
5,728 |
4,749 |
$20K |
| K0003 |
Lightweight wheelchair |
4,883 |
3,573 |
$20K |
| E2611 |
Gen use back cush wdth <22in |
489 |
398 |
$14K |
| E0630 |
Patient lift hydraulic |
1,529 |
1,340 |
$9K |
| K0007 |
Extra heavy duty wheelchair |
539 |
420 |
$8K |
| K0195 |
Elevating whlchair leg rests |
10,390 |
8,742 |
$8K |
| E0973 |
W/ch access det adj armrest |
708 |
202 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
1,556 |
614 |
$6K |
| K0006 |
Heavy duty wheelchair |
656 |
455 |
$4K |
| E0961 |
Wheelchair brake extension |
1,304 |
467 |
$3K |
| K0816 |
Pwc gp 1 std cap chair |
188 |
171 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
256 |
215 |
$3K |
| E0247 |
Trans bench w/wo comm open |
16 |
15 |
$2K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
33 |
26 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
488 |
358 |
$1K |
| E0185 |
Gel pressure mattress pad |
78 |
63 |
$1K |
| E2601 |
Gen w/c cushion wdth < 22 in |
418 |
320 |
$1K |
| E0955 |
Cushioned headrest |
154 |
107 |
$642.20 |
| E0261 |
Hosp bed semi-electr w/o mat |
59 |
53 |
$297.31 |
| K0004 |
High strength ltwt whlchr |
67 |
37 |
$274.02 |
| E0294 |
Hosp bed semi-elect w/ mattr |
49 |
49 |
$251.07 |
| E0181 |
Press pad alternating w/ pum |
44 |
28 |
$231.36 |
| E0156 |
Walker seat attachment |
13 |
13 |
$156.59 |
| K0739 |
Repair/svc dme non-oxygen eq |
73 |
65 |
$0.00 |