| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
1,365 |
1,241 |
$49K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
393 |
370 |
$39K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
448 |
414 |
$37K |
| S9999 |
Sales tax |
2,125 |
1,573 |
$22K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
495 |
438 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
177 |
156 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
359 |
349 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
332 |
266 |
$6K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
96 |
95 |
$4K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
16 |
15 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
43 |
40 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
75 |
67 |
$410.98 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$315.77 |
| E0156 |
Seat attachment, walker |
16 |
14 |
$235.45 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
24 |
24 |
$201.02 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
12 |
12 |
$8.81 |