| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0463 |
Hospital outpt clinic visit |
8,023 |
7,534 |
$780K |
| E2617 |
Custom fab w/c back cushion |
256 |
205 |
$438K |
| E2609 |
Custom fabricate w/c cushion |
324 |
254 |
$433K |
| J0475 |
Baclofen 10 mg injection |
941 |
914 |
$352K |
| 64642 |
|
724 |
681 |
$293K |
| 62369 |
|
1,055 |
1,015 |
$231K |
| K0108 |
W/c component-accessory nos |
794 |
531 |
$118K |
| K0739 |
Repair/svc dme non-oxygen eq |
854 |
692 |
$106K |
| L4002 |
Replace strap, any orthosis |
697 |
520 |
$49K |
| J0585 |
Injection,onabotulinumtoxina |
40 |
39 |
$25K |
| 76770 |
|
474 |
460 |
$22K |
| E0960 |
W/c shoulder harness/straps |
55 |
40 |
$3K |
| E0955 |
Cushioned headrest |
16 |
12 |
$3K |
| 95874 |
|
870 |
822 |
$2K |
| 64643 |
|
121 |
115 |
$1K |
| L4205 |
Ortho dvc repair per 15 min |
27 |
27 |
$953.86 |
| 97530 |
|
19 |
12 |
$817.49 |
| L4210 |
Orth dev repair/repl minor p |
12 |
12 |
$44.89 |