| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
563 |
563 |
$50K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,683 |
1,682 |
$40K |
| K0003 |
Lightweight wheelchair |
776 |
775 |
$12K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,258 |
1,256 |
$6K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
783 |
782 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
118 |
66 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
119 |
65 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
49 |
49 |
$46.09 |