| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
486 |
387 |
$15K |
| A4554 |
Disposable underpads, all sizes |
581 |
534 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
505 |
407 |
$9K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
76 |
75 |
$7K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
83 |
77 |
$7K |
| E0570 |
Nebulizer, with compressor |
75 |
75 |
$6K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
208 |
208 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
475 |
370 |
$1K |
| K0001 |
Standard wheelchair |
227 |
164 |
$1K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
18 |
18 |
$891.48 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
25 |
25 |
$248.95 |