| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,393 |
1,362 |
$146K |
| K0001 |
Standard wheelchair |
3,401 |
3,124 |
$140K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,517 |
1,411 |
$110K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
899 |
856 |
$41K |
| S9999 |
Sales tax |
2,428 |
1,814 |
$32K |
| K0002 |
Standard hemi (low seat) wheelchair |
509 |
479 |
$28K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,269 |
1,239 |
$26K |
| E0627 |
Seat lift mechanism, electric, any type |
86 |
79 |
$22K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
67 |
64 |
$19K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
474 |
331 |
$17K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
346 |
302 |
$16K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
794 |
742 |
$11K |
| K0003 |
Lightweight wheelchair |
109 |
102 |
$9K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
581 |
529 |
$8K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$7K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
137 |
132 |
$4K |
| E0156 |
Seat attachment, walker |
352 |
342 |
$4K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
25 |
25 |
$4K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
131 |
68 |
$3K |
| K0006 |
Heavy duty wheelchair |
13 |
12 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
141 |
138 |
$1K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
184 |
174 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
134 |
126 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
59 |
27 |
$785.07 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
12 |
12 |
$779.72 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
36 |
30 |
$737.97 |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
12 |
12 |
$107.84 |