| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
349 |
347 |
$6K |
| K0003 |
Lightweight wheelchair |
388 |
387 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
753 |
751 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
230 |
218 |
$1K |
| E0305 |
Bed side rails, half length |
294 |
293 |
$822.22 |
| K0002 |
Standard hemi (low seat) wheelchair |
89 |
89 |
$687.38 |