| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
289 |
284 |
$45K |
| E1399 |
Durable medical equipment mi |
1,740 |
1,516 |
$33K |
| K0739 |
Repair/svc dme non-oxygen eq |
473 |
447 |
$16K |
| K0005 |
Ultralightweight wheelchair |
113 |
112 |
$13K |
| K0108 |
W/c component-accessory nos |
106 |
79 |
$9K |
| E0955 |
Cushioned headrest |
281 |
277 |
$6K |
| E1028 |
W/c manual swingaway |
221 |
204 |
$4K |
| T4522 |
Adult size brief/diaper med |
13 |
13 |
$1K |
| K0001 |
Standard wheelchair |
1,682 |
1,563 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
921 |
850 |
$897.24 |
| K0040 |
Adjustable angle footplate |
14 |
14 |
$657.70 |
| E0973 |
W/ch access det adj armrest |
15 |
15 |
$552.48 |
| E2213 |
Pneumatic prop tire insert |
16 |
16 |
$420.85 |
| E0971 |
Wheelchair anti-tipping devi |
16 |
16 |
$356.78 |
| K0004 |
High strength ltwt whlchr |
484 |
463 |
$317.25 |
| E0978 |
W/c acc,saf belt pelv strap |
13 |
13 |
$62.32 |
| E0621 |
Patient lift sling or seat |
150 |
134 |
$35.27 |
| E0184 |
Dry pressure mattress |
1,787 |
1,573 |
$0.00 |
| E0601 |
Cont airway pressure device |
363 |
334 |
$0.00 |
| E1390 |
Oxygen concentrator |
2,510 |
1,870 |
$0.00 |
| E0265 |
Hosp bed total electr w/ mat |
2,493 |
2,466 |
$0.00 |
| E0562 |
Humidifier heated used w pap |
455 |
427 |
$0.00 |
| E0277 |
Powered pres-redu air mattrs |
983 |
920 |
$0.00 |
| E0434 |
Portable liquid 02 |
546 |
545 |
$0.00 |
| E0635 |
Patient lift electric |
292 |
290 |
$0.00 |
| E0303 |
Hosp bed hvy dty xtra wide |
436 |
407 |
$0.00 |
| E0627 |
Seat lift mech, electric any |
463 |
456 |
$0.00 |
| E1038 |
Transport chair pt wt<=300lb |
225 |
223 |
$0.00 |
| E0630 |
Patient lift hydraulic |
24 |
24 |
$0.00 |