| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
5,688 |
5,602 |
$157K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
767 |
666 |
$76K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,464 |
1,341 |
$56K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,718 |
1,714 |
$56K |
| E1399 |
Durable medical equipment, miscellaneous |
302 |
269 |
$27K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,854 |
1,556 |
$14K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
717 |
608 |
$13K |
| E0601 |
Continuous positive airway pressure (cpap) device |
238 |
232 |
$12K |
| E0305 |
Bed side rails, half length |
1,710 |
1,693 |
$7K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
121 |
120 |
$6K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
149 |
148 |
$5K |
| E0245 |
Tub stool or bench |
85 |
85 |
$5K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
53 |
53 |
$2K |
| E0156 |
Seat attachment, walker |
389 |
387 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
12 |
12 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
137 |
136 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
157 |
157 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
71 |
71 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
12 |
12 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$923.01 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
51 |
26 |
$326.72 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
12 |
12 |
$178.36 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12 |
12 |
$132.05 |