| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9999 |
Dme supply or accessory, nos |
659 |
556 |
$51K |
| E1399 |
Durable medical equipment mi |
113 |
83 |
$27K |
| T1999 |
Noc retail items andsupplies |
171 |
121 |
$23K |
| K0739 |
Repair/svc dme non-oxygen eq |
191 |
170 |
$9K |
| K0001 |
Standard wheelchair |
712 |
652 |
$5K |
| E0630 |
Patient lift hydraulic |
159 |
134 |
$4K |
| E1028 |
W/c manual swingaway |
277 |
170 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
219 |
201 |
$2K |
| E0149 |
Heavy duty wheeled walker |
82 |
75 |
$1K |
| K0108 |
W/c component-accessory nos |
41 |
13 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
19 |
13 |
$835.85 |
| K0002 |
Stnd hemi (low seat) whlchr |
121 |
119 |
$815.63 |
| E0156 |
Walker seat attachment |
15 |
14 |
$108.68 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$9.54 |