| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
5,688 |
5,602 |
$157K |
| E1390 |
Oxygen concentrator |
767 |
666 |
$76K |
| E0143 |
Walker folding wheeled w/o s |
1,464 |
1,341 |
$56K |
| E0295 |
Hosp bed semi-elect w/o matt |
1,718 |
1,714 |
$56K |
| E1399 |
Durable medical equipment mi |
302 |
269 |
$27K |
| K0195 |
Elevating whlchair leg rests |
1,854 |
1,556 |
$14K |
| E0431 |
Portable gaseous 02 |
717 |
608 |
$13K |
| E0601 |
Cont airway pressure device |
238 |
232 |
$12K |
| E0305 |
Rails bed side half length |
1,710 |
1,693 |
$7K |
| E2611 |
Gen use back cush wdth <22in |
121 |
120 |
$6K |
| E0163 |
Commode chair with fixed arm |
149 |
148 |
$5K |
| E0245 |
Tub stool or bench |
85 |
85 |
$5K |
| T4542 |
Small disposable underpad |
53 |
53 |
$2K |
| E0156 |
Walker seat attachment |
389 |
387 |
$2K |
| A5512 |
Multi den insert direct form |
12 |
12 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
137 |
136 |
$2K |
| E1038 |
Transport chair pt wt<=300lb |
157 |
157 |
$2K |
| K0002 |
Stnd hemi (low seat) whlchr |
71 |
71 |
$2K |
| A5500 |
Diab shoe for density insert |
12 |
12 |
$2K |
| E0247 |
Trans bench w/wo comm open |
12 |
12 |
$923.01 |
| E0971 |
Wheelchair anti-tipping devi |
51 |
26 |
$326.72 |
| E0443 |
Portable 02 contents, gas |
12 |
12 |
$178.36 |
| A6250 |
Skin seal protect moisturizr |
12 |
12 |
$132.05 |