| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
7,974 |
7,658 |
$444K |
| K0108 |
W/c component-accessory nos |
4,937 |
1,849 |
$402K |
| E1028 |
W/c manual swingaway |
5,488 |
3,909 |
$296K |
| E0601 |
Cont airway pressure device |
6,536 |
6,414 |
$287K |
| K0823 |
Pwc gp 2 std cap chair |
2,344 |
2,068 |
$284K |
| E1161 |
Manual adult wc w tiltinspac |
543 |
488 |
$265K |
| T2029 |
Special med equip, noswaiver |
310 |
269 |
$205K |
| A7030 |
Cpap full face mask |
2,505 |
2,440 |
$149K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,126 |
2,975 |
$131K |
| E1399 |
Durable medical equipment mi |
457 |
76 |
$125K |
| E0470 |
Rad w/o backup non-inv intfc |
962 |
934 |
$118K |
| K0003 |
Lightweight wheelchair |
2,533 |
2,433 |
$106K |
| E0570 |
Nebulizer with compression |
2,310 |
2,218 |
$101K |
| E0973 |
W/ch access det adj armrest |
1,440 |
902 |
$95K |
| E0431 |
Portable gaseous 02 |
4,629 |
4,467 |
$94K |
| K0825 |
Pwc gp 2 hd cap chair |
587 |
523 |
$89K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,280 |
2,780 |
$88K |
| E0562 |
Humidifier heated used w pap |
602 |
586 |
$86K |
| E0955 |
Cushioned headrest |
1,286 |
1,033 |
$85K |
| B4152 |
Ef calorie dense>/=1.5kcal |
863 |
570 |
$78K |
| E2361 |
22nf sealed leadacid battery |
620 |
523 |
$78K |
| K0001 |
Standard wheelchair |
2,762 |
2,636 |
$73K |
| E2617 |
Custom fab w/c back cushion |
135 |
100 |
$67K |
| E0471 |
Rad w/backup non inv intrfc |
274 |
273 |
$64K |
| A7035 |
Pos airway press headgear |
3,078 |
3,009 |
$60K |
| A7034 |
Nasal application device |
1,631 |
1,594 |
$59K |
| E2609 |
Custom fabricate w/c cushion |
125 |
90 |
$54K |
| A7037 |
Pos airway pressure tubing |
3,505 |
3,427 |
$51K |
| E0603 |
Electric breast pump |
315 |
313 |
$48K |
| E0971 |
Wheelchair anti-tipping devi |
874 |
674 |
$38K |
| E0143 |
Walker folding wheeled w/o s |
1,021 |
959 |
$32K |
| B4150 |
Ef complet w/intact nutrient |
697 |
433 |
$32K |
| K0040 |
Adjustable angle footplate |
416 |
310 |
$29K |
| K0004 |
High strength ltwt whlchr |
500 |
444 |
$28K |
| E0956 |
W/c lateral trunk/hip suppor |
370 |
190 |
$28K |
| K0738 |
Portable gas oxygen system |
951 |
924 |
$23K |
| E0990 |
Wheelchair elevating leg res |
185 |
158 |
$23K |
| E0630 |
Patient lift hydraulic |
581 |
495 |
$20K |
| L3908 |
Who cock-up nonmolde pre ots |
600 |
428 |
$18K |
| A6530 |
Compression stocking bk18-30 |
423 |
288 |
$17K |
| E2365 |
U1 sealed leadacid battery |
223 |
187 |
$16K |
| E2311 |
Electro connect btw 2 sys |
17 |
13 |
$13K |
| K0007 |
Extra heavy duty wheelchair |
66 |
62 |
$12K |
| E0303 |
Hosp bed hvy dty xtra wide |
78 |
75 |
$12K |
| E0978 |
W/c acc,saf belt pelv strap |
574 |
502 |
$12K |
| E0247 |
Trans bench w/wo comm open |
196 |
189 |
$12K |
| A7038 |
Pos airway pressure filter |
5,214 |
5,015 |
$11K |
| A7039 |
Filter, non disposable w pap |
1,446 |
1,404 |
$11K |
| E0245 |
Tub stool or bench |
301 |
298 |
$11K |
| E0163 |
Commode chair with fixed arm |
304 |
292 |
$9K |
| E2392 |
Solid caster tire, integrate |
146 |
105 |
$9K |
| E2601 |
Gen w/c cushion wdth < 22 in |
284 |
264 |
$8K |
| E0149 |
Heavy duty wheeled walker |
290 |
271 |
$6K |
| K0195 |
Elevating whlchair leg rests |
1,550 |
1,438 |
$6K |
| E2607 |
Skin pro/pos wc cus wd <22in |
31 |
25 |
$5K |
| A7003 |
Nebulizer administration set |
1,669 |
1,329 |
$5K |
| E2611 |
Gen use back cush wdth <22in |
47 |
38 |
$5K |
| E0114 |
Crutch underarm pair no wood |
270 |
261 |
$5K |
| E2620 |
Wc planar back cush wd <22in |
15 |
12 |
$5K |
| L4360 |
Pneumat walking boot pre cst |
40 |
40 |
$4K |
| A6533 |
Gc stocking thighlngth 18-30 |
97 |
70 |
$4K |
| E2622 |
Adj skin pro w/c cus wd<22in |
14 |
13 |
$3K |
| E0165 |
Commode chair with detacharm |
220 |
204 |
$3K |
| E0951 |
Loop heel |
231 |
152 |
$3K |
| A4604 |
Tubing with heating element |
100 |
95 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,108 |
1,010 |
$3K |
| E0277 |
Powered pres-redu air mattrs |
15 |
14 |
$3K |
| K0006 |
Heavy duty wheelchair |
12 |
12 |
$2K |
| E2377 |
Expandable controller, initl |
15 |
12 |
$2K |
| E0960 |
W/c shoulder harness/straps |
45 |
36 |
$2K |
| E0156 |
Walker seat attachment |
296 |
280 |
$2K |
| A4467 |
Belt strap sleev grmnt cover |
68 |
64 |
$2K |
| K0019 |
Arm pad repl, each |
216 |
156 |
$2K |
| E2213 |
Pneumatic prop tire insert |
56 |
43 |
$2K |
| E2386 |
Foam filled drive wheel tire |
24 |
14 |
$2K |
| E2313 |
Pwc harness, expand control |
15 |
12 |
$2K |
| E2366 |
Battery charger, single mode |
13 |
13 |
$2K |
| E0100 |
Cane adjust/fixed with tip |
273 |
264 |
$2K |
| E0244 |
Toilet seat raised |
39 |
39 |
$2K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
17 |
12 |
$1K |
| E0950 |
Tray |
14 |
13 |
$1K |
| A7046 |
Repl water chamber, pap dev |
242 |
232 |
$923.03 |
| E0961 |
Wheelchair brake extension |
32 |
25 |
$803.90 |
| A7036 |
Pos airway press chinstrap |
78 |
77 |
$668.08 |
| E2211 |
Pneumatic propulsion tire |
22 |
12 |
$525.83 |
| E0181 |
Press pad alternating w/ pum |
39 |
39 |
$217.83 |