| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,466 |
357 |
$249K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
159 |
144 |
$77K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$19K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
263 |
144 |
$14K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
182 |
172 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
341 |
182 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
12 |
12 |
$2K |
| K0040 |
Adjustable angle footplate, each |
12 |
12 |
$1K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
3,532 |
3,491 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
33 |
27 |
$1K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
119 |
117 |
$402.44 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
180 |
180 |
$325.92 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
49 |
48 |
$203.46 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
56 |
52 |
$151.30 |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
14 |
13 |
$149.69 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
13 |
13 |
$129.79 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
14 |
12 |
$128.97 |
| A4217 |
Sterile water/saline, 500 ml |
12 |
12 |
$14.40 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
165 |
113 |
$0.00 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
13 |
13 |
$0.00 |