| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Cont airway pressure device |
1,203 |
1,199 |
$54K |
| K0108 |
W/c component-accessory nos |
373 |
192 |
$33K |
| E1028 |
W/c manual swingaway |
691 |
474 |
$31K |
| E0562 |
Humidifier heated used w pap |
1,669 |
1,641 |
$27K |
| E1161 |
Manual adult wc w tiltinspac |
77 |
77 |
$22K |
| E0973 |
W/ch access det adj armrest |
763 |
422 |
$16K |
| K0040 |
Adjustable angle footplate |
277 |
158 |
$7K |
| K0739 |
Repair/svc dme non-oxygen eq |
212 |
190 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
437 |
240 |
$5K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
51 |
51 |
$4K |
| E0955 |
Cushioned headrest |
52 |
52 |
$4K |
| A4604 |
Tubing with heating element |
94 |
94 |
$3K |
| E2219 |
Foam caster tire any size ea |
96 |
68 |
$3K |
| K0001 |
Standard wheelchair |
63 |
63 |
$2K |
| E0630 |
Patient lift hydraulic |
37 |
37 |
$2K |
| A7030 |
Cpap full face mask |
13 |
13 |
$1K |
| A7038 |
Pos airway pressure filter |
232 |
230 |
$904.59 |
| A7035 |
Pos airway press headgear |
46 |
46 |
$864.62 |
| T4535 |
Disposable liner/shield/pad |
13 |
13 |
$760.40 |
| E0961 |
Wheelchair brake extension |
41 |
25 |
$671.90 |
| A7031 |
Replacement facemask interfa |
15 |
15 |
$615.03 |
| E0951 |
Loop heel |
43 |
26 |
$424.95 |
| E0978 |
W/c acc,saf belt pelv strap |
39 |
39 |
$378.09 |