| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
130 |
13 |
$26K |
| K0001 |
Standard wheelchair |
379 |
378 |
$15K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
241 |
157 |
$13K |
| E0601 |
Continuous positive airway pressure (cpap) device |
172 |
171 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
108 |
108 |
$8K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
64 |
62 |
$5K |
| E1399 |
Durable medical equipment, miscellaneous |
24 |
13 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
18 |
18 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
27 |
25 |
$770.83 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14 |
14 |
$741.10 |
| E0305 |
Bed side rails, half length |
28 |
27 |
$315.57 |
| E0272 |
Mattress, foam rubber |
12 |
12 |
$163.35 |