| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
289 |
284 |
$45K |
| E1399 |
Durable medical equipment, miscellaneous |
1,740 |
1,516 |
$33K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
473 |
447 |
$16K |
| K0005 |
Ultralightweight wheelchair |
113 |
112 |
$13K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
106 |
79 |
$9K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
281 |
277 |
$6K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
221 |
204 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
13 |
$1K |
| K0001 |
Standard wheelchair |
1,682 |
1,563 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
921 |
850 |
$897.24 |
| K0040 |
Adjustable angle footplate, each |
14 |
14 |
$657.70 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
15 |
15 |
$552.48 |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
16 |
16 |
$420.85 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
16 |
16 |
$356.78 |
| K0004 |
High strength, lightweight wheelchair |
484 |
463 |
$317.25 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
13 |
13 |
$62.32 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
150 |
134 |
$35.27 |
| E0184 |
Dry pressure mattress |
1,787 |
1,573 |
$0.00 |
| E0601 |
Continuous positive airway pressure (cpap) device |
363 |
334 |
$0.00 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,510 |
1,870 |
$0.00 |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
2,493 |
2,466 |
$0.00 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
455 |
427 |
$0.00 |
| E0277 |
Powered pressure-reducing air mattress |
983 |
920 |
$0.00 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
546 |
545 |
$0.00 |
| E0635 |
Patient lift, electric with seat or sling |
292 |
290 |
$0.00 |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
436 |
407 |
$0.00 |
| E0627 |
Seat lift mechanism, electric, any type |
463 |
456 |
$0.00 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
225 |
223 |
$0.00 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
24 |
24 |
$0.00 |