| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
449 |
171 |
$63K |
| K0001 |
Standard wheelchair |
1,527 |
1,514 |
$26K |
| E1028 |
W/c manual swingaway |
562 |
506 |
$24K |
| E1399 |
Durable medical equipment mi |
62 |
14 |
$20K |
| K0823 |
Pwc gp 2 std cap chair |
286 |
286 |
$15K |
| E0260 |
Hosp bed semi-electr w/ matt |
541 |
538 |
$14K |
| K0007 |
Extra heavy duty wheelchair |
176 |
174 |
$10K |
| E0143 |
Walker folding wheeled w/o s |
270 |
268 |
$10K |
| E0973 |
W/ch access det adj armrest |
84 |
84 |
$7K |
| K0739 |
Repair/svc dme non-oxygen eq |
179 |
178 |
$6K |
| E1390 |
Oxygen concentrator |
247 |
246 |
$6K |
| E0955 |
Cushioned headrest |
75 |
75 |
$6K |
| E0630 |
Patient lift hydraulic |
164 |
164 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
165 |
163 |
$6K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
271 |
267 |
$5K |
| K0006 |
Heavy duty wheelchair |
86 |
86 |
$4K |
| K0003 |
Lightweight wheelchair |
274 |
272 |
$4K |
| K0195 |
Elevating whlchair leg rests |
528 |
518 |
$4K |
| K0040 |
Adjustable angle footplate |
40 |
40 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
16 |
15 |
$2K |
| E0601 |
Cont airway pressure device |
457 |
456 |
$2K |
| E0165 |
Commode chair with detacharm |
50 |
50 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
76 |
76 |
$2K |
| E0990 |
Wheelchair elevating leg res |
72 |
72 |
$2K |
| A7030 |
Cpap full face mask |
54 |
54 |
$1K |
| E0149 |
Heavy duty wheeled walker |
98 |
97 |
$1K |
| E0118 |
Crutch substitute |
12 |
12 |
$1K |
| E0570 |
Nebulizer with compression |
39 |
39 |
$1K |
| A4604 |
Tubing with heating element |
205 |
204 |
$1K |
| E0700 |
Safety equipment |
13 |
13 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
41 |
41 |
$1K |
| A7034 |
Nasal application device |
95 |
94 |
$1K |
| E0951 |
Loop heel |
76 |
74 |
$988.03 |
| A7035 |
Pos airway press headgear |
200 |
199 |
$801.16 |
| E0431 |
Portable gaseous 02 |
124 |
124 |
$739.07 |
| E0156 |
Walker seat attachment |
93 |
88 |
$496.34 |
| A7038 |
Pos airway pressure filter |
288 |
286 |
$303.66 |
| E0562 |
Humidifier heated used w pap |
12 |
12 |
$140.40 |
| A7046 |
Repl water chamber, pap dev |
54 |
54 |
$129.48 |