| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0003 |
Lightweight wheelchair |
2,681 |
2,679 |
$22K |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
495 |
247 |
$6K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
77 |
77 |
$6K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
362 |
362 |
$5K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
106 |
77 |
$2K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
1,048 |
738 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
98 |
98 |
$1K |
| E0849 |
Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
137 |
137 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
26 |
26 |
$932.64 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
152 |
152 |
$613.62 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
52 |
26 |
$586.87 |
| L2810 |
Addition to lower extremity orthosis, knee control, condylar pad |
65 |
36 |
$312.16 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
52 |
26 |
$307.64 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
26 |
26 |
$204.71 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
48 |
24 |
$170.81 |
| E0156 |
Seat attachment, walker |
39 |
39 |
$131.33 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
52 |
26 |
$130.75 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
26 |
26 |
$117.51 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
28 |
28 |
$8.02 |
| L0462 |
Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
129 |
129 |
$0.00 |