| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
579 |
572 |
$42K |
| K0003 |
Lightweight wheelchair |
2,175 |
2,153 |
$39K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
434 |
418 |
$13K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
47 |
25 |
$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 |
42 |
42 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
57 |
55 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
53 |
52 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
429 |
414 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
55 |
54 |
$1K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
27 |
14 |
$955.48 |
| A7037 |
Tubing used with positive airway pressure device |
204 |
201 |
$893.17 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
32 |
32 |
$651.50 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
66 |
64 |
$498.86 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
137 |
136 |
$366.87 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
248 |
244 |
$349.68 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
55 |
55 |
$297.97 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
16 |
12 |
$151.49 |