| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
4,943 |
2,682 |
$24K |
| A5120 |
Skin barrier, wipes or swabs, each |
851 |
734 |
$14K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
435 |
292 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,943 |
1,068 |
$1K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
43 |
14 |
$217.61 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
21 |
12 |
$198.57 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$60.12 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
43 |
14 |
$47.23 |