| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
130 |
13 |
$26K |
| K0001 |
Standard wheelchair |
379 |
378 |
$15K |
| K0739 |
Repair/svc dme non-oxygen eq |
241 |
157 |
$13K |
| E0601 |
Cont airway pressure device |
172 |
171 |
$13K |
| E0143 |
Walker folding wheeled w/o s |
108 |
108 |
$8K |
| E0295 |
Hosp bed semi-elect w/o matt |
64 |
62 |
$5K |
| E1399 |
Durable medical equipment mi |
24 |
13 |
$4K |
| E0562 |
Humidifier heated used w pap |
18 |
18 |
$2K |
| A7035 |
Pos airway press headgear |
27 |
25 |
$770.83 |
| A7038 |
Pos airway pressure filter |
14 |
14 |
$741.10 |
| E0305 |
Rails bed side half length |
28 |
27 |
$315.57 |
| E0272 |
Mattress foam rubber |
12 |
12 |
$163.35 |