| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
1,393 |
1,362 |
$146K |
| K0001 |
Standard wheelchair |
3,401 |
3,124 |
$140K |
| E0630 |
Patient lift hydraulic |
1,517 |
1,411 |
$110K |
| E0143 |
Walker folding wheeled w/o s |
899 |
856 |
$41K |
| S9999 |
Sales tax |
2,428 |
1,814 |
$32K |
| K0002 |
Stnd hemi (low seat) whlchr |
509 |
479 |
$28K |
| E0431 |
Portable gaseous 02 |
1,269 |
1,239 |
$26K |
| E0627 |
Seat lift mech, electric any |
86 |
79 |
$22K |
| E0295 |
Hosp bed semi-elect w/o matt |
67 |
64 |
$19K |
| E1028 |
W/c manual swingaway |
474 |
331 |
$17K |
| E0600 |
Suction pump portab hom modl |
346 |
302 |
$16K |
| E0260 |
Hosp bed semi-electr w/ matt |
794 |
742 |
$11K |
| K0003 |
Lightweight wheelchair |
109 |
102 |
$9K |
| E0261 |
Hosp bed semi-electr w/o mat |
581 |
529 |
$8K |
| E0240 |
Bath/shower chair |
12 |
12 |
$7K |
| E0990 |
Wheelchair elevating leg res |
137 |
132 |
$4K |
| E0156 |
Walker seat attachment |
352 |
342 |
$4K |
| E0247 |
Trans bench w/wo comm open |
25 |
25 |
$4K |
| E0973 |
W/ch access det adj armrest |
131 |
68 |
$3K |
| K0006 |
Heavy duty wheelchair |
13 |
12 |
$1K |
| K0195 |
Elevating whlchair leg rests |
141 |
138 |
$1K |
| E0181 |
Press pad alternating w/ pum |
184 |
174 |
$1K |
| A7038 |
Pos airway pressure filter |
134 |
126 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
59 |
27 |
$785.07 |
| A4606 |
Oxygen probe used w oximeter |
12 |
12 |
$779.72 |
| E2601 |
Gen w/c cushion wdth < 22 in |
36 |
30 |
$737.97 |
| E0955 |
Cushioned headrest |
12 |
12 |
$107.84 |