| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
3,948 |
3,651 |
$171K |
| K0003 |
Lightweight wheelchair |
1,846 |
1,684 |
$145K |
| E0143 |
Walker folding wheeled w/o s |
1,811 |
1,702 |
$88K |
| S9999 |
Sales tax |
3,767 |
2,960 |
$46K |
| E0990 |
Wheelchair elevating leg res |
1,087 |
1,008 |
$39K |
| E0630 |
Patient lift hydraulic |
633 |
594 |
$33K |
| K0002 |
Stnd hemi (low seat) whlchr |
644 |
597 |
$26K |
| E1028 |
W/c manual swingaway |
602 |
443 |
$20K |
| E0971 |
Wheelchair anti-tipping devi |
631 |
318 |
$15K |
| E0156 |
Walker seat attachment |
985 |
931 |
$13K |
| E1390 |
Oxygen concentrator |
113 |
104 |
$11K |
| E0260 |
Hosp bed semi-electr w/ matt |
454 |
439 |
$6K |
| K0195 |
Elevating whlchair leg rests |
606 |
569 |
$6K |
| K0006 |
Heavy duty wheelchair |
67 |
64 |
$5K |
| E2601 |
Gen w/c cushion wdth < 22 in |
155 |
145 |
$4K |
| E0431 |
Portable gaseous 02 |
169 |
161 |
$3K |
| E0973 |
W/ch access det adj armrest |
277 |
141 |
$3K |
| E0261 |
Hosp bed semi-electr w/o mat |
153 |
145 |
$2K |
| E0955 |
Cushioned headrest |
58 |
50 |
$2K |
| E0247 |
Trans bench w/wo comm open |
14 |
13 |
$1K |
| K0004 |
High strength ltwt whlchr |
24 |
24 |
$1K |
| E0181 |
Press pad alternating w/ pum |
174 |
159 |
$960.86 |
| E0600 |
Suction pump portab hom modl |
13 |
13 |
$404.04 |
| A7038 |
Pos airway pressure filter |
38 |
37 |
$309.65 |