| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Whlchr special size/constrc |
163 |
148 |
$998K |
| E1390 |
Oxygen concentrator |
12,011 |
10,994 |
$528K |
| K0108 |
W/c component-accessory nos |
508 |
306 |
$485K |
| E0466 |
Home vent non-invasive inter |
999 |
926 |
$275K |
| E1399 |
Durable medical equipment mi |
110 |
82 |
$158K |
| E0601 |
Cont airway pressure device |
3,488 |
3,175 |
$102K |
| E0431 |
Portable gaseous 02 |
7,740 |
7,052 |
$82K |
| E0261 |
Hosp bed semi-electr w/o mat |
2,462 |
2,242 |
$67K |
| K0823 |
Pwc gp 2 std cap chair |
982 |
835 |
$66K |
| E0470 |
Rad w/o backup non-inv intfc |
1,070 |
951 |
$64K |
| E0260 |
Hosp bed semi-electr w/ matt |
982 |
885 |
$33K |
| E1161 |
Manual adult wc w tiltinspac |
44 |
15 |
$32K |
| K0005 |
Ultralightweight wheelchair |
19 |
19 |
$31K |
| E0971 |
Wheelchair anti-tipping devi |
4,780 |
2,377 |
$25K |
| E1028 |
W/c manual swingaway |
1,029 |
614 |
$24K |
| E0570 |
Nebulizer with compression |
2,568 |
2,325 |
$22K |
| A7030 |
Cpap full face mask |
434 |
374 |
$21K |
| E0973 |
W/ch access det adj armrest |
352 |
213 |
$19K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,052 |
971 |
$18K |
| K0004 |
High strength ltwt whlchr |
937 |
883 |
$17K |
| K0001 |
Standard wheelchair |
1,691 |
1,568 |
$14K |
| E2620 |
Wc planar back cush wd <22in |
67 |
40 |
$14K |
| E1392 |
Portable oxygen concentrator |
1,220 |
1,124 |
$13K |
| E0143 |
Walker folding wheeled w/o s |
604 |
530 |
$13K |
| A7037 |
Pos airway pressure tubing |
1,053 |
908 |
$11K |
| E0955 |
Cushioned headrest |
161 |
125 |
$11K |
| A7031 |
Replacement facemask interfa |
397 |
355 |
$10K |
| A7035 |
Pos airway press headgear |
808 |
676 |
$7K |
| E0562 |
Humidifier heated used w pap |
68 |
63 |
$6K |
| E2611 |
Gen use back cush wdth <22in |
106 |
100 |
$5K |
| A7038 |
Pos airway pressure filter |
1,143 |
931 |
$4K |
| E0630 |
Patient lift hydraulic |
101 |
92 |
$4K |
| K0040 |
Adjustable angle footplate |
84 |
41 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
48 |
17 |
$3K |
| E0961 |
Wheelchair brake extension |
114 |
65 |
$2K |
| E0163 |
Commode chair with fixed arm |
71 |
65 |
$2K |
| E0951 |
Loop heel |
106 |
60 |
$1K |
| E2211 |
Pneumatic propulsion tire |
14 |
12 |
$820.66 |
| K0739 |
Repair/svc dme non-oxygen eq |
14 |
12 |
$771.15 |
| E2601 |
Gen w/c cushion wdth < 22 in |
41 |
40 |
$345.05 |
| A7032 |
Replacement nasal cushion |
13 |
12 |
$341.77 |
| E0156 |
Walker seat attachment |
72 |
69 |
$243.42 |
| A7039 |
Filter, non disposable w pap |
59 |
52 |
$237.55 |
| A7003 |
Nebulizer administration set |
66 |
63 |
$85.38 |
| A7046 |
Repl water chamber, pap dev |
13 |
12 |
$75.50 |