| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
501 |
442 |
$840K |
| K0108 |
W/c component-accessory nos |
2,653 |
1,412 |
$268K |
| B4150 |
Ef complet w/intact nutrient |
1,305 |
1,293 |
$127K |
| E1161 |
Manual adult wc w tiltinspac |
338 |
333 |
$80K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,840 |
1,761 |
$67K |
| B4035 |
Enteral feed supp pump per d |
339 |
335 |
$63K |
| E1028 |
W/c manual swingaway |
865 |
572 |
$62K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
198 |
193 |
$36K |
| B4087 |
Gastro/jejuno tube, std |
452 |
426 |
$27K |
| T1999 |
Noc retail items andsupplies |
154 |
144 |
$23K |
| B4088 |
Gastro/jejuno tube, low-pro |
131 |
129 |
$14K |
| E0971 |
Wheelchair anti-tipping devi |
987 |
611 |
$11K |
| E0955 |
Cushioned headrest |
129 |
126 |
$11K |
| K0040 |
Adjustable angle footplate |
169 |
166 |
$10K |
| K0001 |
Standard wheelchair |
224 |
208 |
$7K |
| E0603 |
Electric breast pump |
41 |
41 |
$5K |
| K0004 |
High strength ltwt whlchr |
102 |
102 |
$5K |
| S5199 |
Personal care item nos each |
28 |
26 |
$4K |
| A4927 |
Non-sterile gloves |
196 |
194 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
65 |
65 |
$1K |
| E2211 |
Pneumatic propulsion tire |
41 |
36 |
$1K |
| E0960 |
W/c shoulder harness/straps |
12 |
12 |
$835.75 |
| A7000 |
Disposable canister for pump |
29 |
28 |
$176.45 |
| A7002 |
Tubing used w suction pump |
15 |
14 |
$107.58 |