| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0004 |
High strength ltwt whlchr |
5,497 |
5,455 |
$126K |
| K0003 |
Lightweight wheelchair |
5,589 |
5,545 |
$90K |
| E0143 |
Walker folding wheeled w/o s |
2,882 |
2,867 |
$70K |
| A5500 |
Diab shoe for density insert |
1,325 |
737 |
$32K |
| K0823 |
Pwc gp 2 std cap chair |
344 |
343 |
$19K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
230 |
230 |
$15K |
| L1820 |
Ko elas w/ condyle pads & jo |
1,001 |
536 |
$14K |
| E0156 |
Walker seat attachment |
2,557 |
2,538 |
$13K |
| L1812 |
Ko elastic w/joints pre ots |
253 |
201 |
$12K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
242 |
242 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
811 |
805 |
$8K |
| E2611 |
Gen use back cush wdth <22in |
152 |
152 |
$6K |
| K0001 |
Standard wheelchair |
335 |
328 |
$3K |
| A5512 |
Multi den insert direct form |
1,319 |
737 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
153 |
153 |
$1K |
| E0210 |
Electric heat pad standard |
12 |
12 |
$681.40 |
| E0100 |
Cane adjust/fixed with tip |
104 |
104 |
$486.82 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$423.53 |
| E0105 |
Cane adjust/fixed quad/3 pro |
63 |
63 |
$347.99 |
| K0739 |
Repair/svc dme non-oxygen eq |
82 |
75 |
$196.04 |