| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,410 |
1,283 |
$2.49M |
| K0108 |
W/c component-accessory nos |
5,632 |
4,898 |
$2.41M |
| E1161 |
Manual adult wc w tiltinspac |
5,177 |
5,151 |
$2.21M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
274 |
273 |
$1.39M |
| K0739 |
Repair/svc dme non-oxygen eq |
6,347 |
6,232 |
$1.16M |
| K0005 |
Ultralightweight wheelchair |
662 |
660 |
$1.04M |
| E2361 |
22nf sealed leadacid battery |
1,578 |
1,564 |
$560K |
| E2617 |
Custom fab w/c back cushion |
485 |
481 |
$503K |
| E1007 |
Pwr seat combo w/shear |
107 |
105 |
$481K |
| E0955 |
Cushioned headrest |
6,578 |
6,520 |
$429K |
| E2620 |
Wc planar back cush wd <22in |
1,322 |
1,310 |
$419K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,649 |
1,631 |
$392K |
| E2311 |
Electro connect btw 2 sys |
337 |
336 |
$361K |
| E0956 |
W/c lateral trunk/hip suppor |
2,059 |
1,742 |
$339K |
| K0040 |
Adjustable angle footplate |
3,820 |
2,968 |
$284K |
| E1028 |
W/c manual swingaway |
5,427 |
4,353 |
$275K |
| E1012 |
Ctr mount pwr elev leg rest |
367 |
366 |
$261K |
| E1002 |
Pwr seat tilt |
108 |
106 |
$210K |
| E2609 |
Custom fabricate w/c cushion |
190 |
187 |
$169K |
| E1236 |
Folding ped wc adjustable |
102 |
98 |
$165K |
| E0960 |
W/c shoulder harness/straps |
2,294 |
2,267 |
$159K |
| E0971 |
Wheelchair anti-tipping devi |
3,503 |
2,641 |
$154K |
| K0856 |
Pwc gp3 std sing pow opt s/b |
43 |
41 |
$152K |
| E0950 |
Tray |
1,115 |
1,108 |
$115K |
| E0973 |
W/ch access det adj armrest |
1,600 |
1,143 |
$96K |
| K0823 |
Pwc gp 2 std cap chair |
217 |
217 |
$91K |
| E2386 |
Foam filled drive wheel tire |
332 |
267 |
$86K |
| E1234 |
Fld ped wc tltnspc w/o seat |
37 |
37 |
$77K |
| E2615 |
Pos back post/lat wdth <22in |
234 |
228 |
$74K |
| E2377 |
Expandable controller, initl |
243 |
242 |
$71K |
| E2231 |
Solid seat support base |
618 |
611 |
$64K |
| E2213 |
Pneumatic prop tire insert |
1,909 |
1,436 |
$61K |
| E2313 |
Pwc harness, expand control |
287 |
286 |
$59K |
| E2211 |
Pneumatic propulsion tire |
1,542 |
1,139 |
$53K |
| E0951 |
Loop heel |
2,182 |
1,634 |
$38K |
| K0019 |
Arm pad repl, each |
1,098 |
846 |
$33K |
| E2392 |
Solid caster tire, integrate |
277 |
231 |
$33K |
| E2624 |
Adj skin pro/pos cus<22in |
111 |
110 |
$28K |
| E0978 |
W/c acc,saf belt pelv strap |
1,255 |
1,238 |
$26K |
| E2394 |
Drive wheel excludes tire |
363 |
287 |
$25K |
| E2300 |
Pwr seat elevation sys |
13 |
13 |
$24K |
| E2622 |
Adj skin pro w/c cus wd<22in |
110 |
109 |
$20K |
| E2370 |
Pwr wc dr wh motor/gear comb |
26 |
25 |
$16K |
| E0961 |
Wheelchair brake extension |
578 |
438 |
$13K |
| E2298 |
Pwr seat elev sys for crt |
13 |
13 |
$12K |
| E8000 |
Posterior gait trainer |
13 |
13 |
$11K |
| E2206 |
Man wc whl lock comp repl ea |
226 |
185 |
$11K |
| E2395 |
Caster wheel excludes tire |
101 |
81 |
$8K |
| K0038 |
Leg strap each |
336 |
322 |
$6K |
| K0077 |
Fr cstr asmb sol tire rep ea |
91 |
72 |
$5K |
| E2374 |
Hand/chin ctrl std joystick |
12 |
12 |
$4K |
| E2203 |
Frame depth less than 22 in |
15 |
14 |
$4K |
| E2363 |
Gr24 sealed leadacid battery |
13 |
12 |
$4K |
| E2389 |
Foam caster tire |
71 |
57 |
$3K |
| E2224 |
Propulsion whl excl tire rep |
17 |
15 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
26 |
18 |
$2K |
| E2366 |
Battery charger, single mode |
12 |
12 |
$2K |
| E2210 |
Wheelchair bearings |
111 |
110 |
$2K |
| E0957 |
W/c medial thigh support |
13 |
12 |
$2K |
| E0952 |
Toe loop/holder, each |
53 |
40 |
$1K |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$3.04 |