| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
13,039 |
7,356 |
$3.54M |
| E2617 |
Custom fab w/c back cushion |
2,315 |
1,936 |
$2.94M |
| E1161 |
Manual adult wc w tiltinspac |
4,827 |
4,350 |
$2.28M |
| E1399 |
Durable medical equipment mi |
1,547 |
1,022 |
$2.04M |
| K0005 |
Ultralightweight wheelchair |
1,347 |
1,019 |
$1.92M |
| E1007 |
Pwr seat combo w/shear |
307 |
233 |
$1.71M |
| E1028 |
W/c manual swingaway |
10,045 |
7,783 |
$1.69M |
| E2609 |
Custom fabricate w/c cushion |
1,195 |
945 |
$1.50M |
| K0739 |
Repair/svc dme non-oxygen eq |
9,489 |
7,623 |
$888K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
235 |
176 |
$888K |
| E2311 |
Electro connect btw 2 sys |
579 |
450 |
$862K |
| E0973 |
W/ch access det adj armrest |
4,625 |
3,376 |
$712K |
| E0955 |
Cushioned headrest |
7,966 |
6,827 |
$623K |
| E0956 |
W/c lateral trunk/hip suppor |
2,918 |
2,053 |
$504K |
| E1012 |
Ctr mount pwr elev leg rest |
315 |
255 |
$455K |
| K0040 |
Adjustable angle footplate |
4,350 |
3,221 |
$419K |
| E2620 |
Wc planar back cush wd <22in |
916 |
686 |
$336K |
| E0986 |
Man w/c powr assist syst |
128 |
110 |
$269K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,143 |
889 |
$243K |
| E0971 |
Wheelchair anti-tipping devi |
3,976 |
2,878 |
$241K |
| E2361 |
22nf sealed leadacid battery |
1,219 |
943 |
$231K |
| E0960 |
W/c shoulder harness/straps |
3,073 |
2,366 |
$224K |
| E2624 |
Adj skin pro/pos cus<22in |
869 |
654 |
$213K |
| E0978 |
W/c acc,saf belt pelv strap |
4,781 |
3,621 |
$153K |
| E2622 |
Adj skin pro w/c cus wd<22in |
624 |
476 |
$153K |
| E2313 |
Pwc harness, expand control |
496 |
376 |
$142K |
| E2377 |
Expandable controller, initl |
448 |
343 |
$142K |
| E2231 |
Solid seat support base |
1,263 |
996 |
$140K |
| E1002 |
Pwr seat tilt |
59 |
43 |
$133K |
| E2615 |
Pos back post/lat wdth <22in |
386 |
284 |
$132K |
| E2213 |
Pneumatic prop tire insert |
3,009 |
2,162 |
$128K |
| E2203 |
Frame depth less than 22 in |
304 |
239 |
$110K |
| E2211 |
Pneumatic propulsion tire |
2,157 |
1,536 |
$110K |
| E0950 |
Tray |
1,019 |
778 |
$91K |
| E0951 |
Loop heel |
2,964 |
2,093 |
$69K |
| E1225 |
Manual semi-reclining back |
442 |
414 |
$64K |
| E2374 |
Hand/chin ctrl std joystick |
205 |
157 |
$59K |
| E0961 |
Wheelchair brake extension |
1,256 |
858 |
$47K |
| E0990 |
Wheelchair elevating leg res |
250 |
193 |
$38K |
| K0019 |
Arm pad repl, each |
1,641 |
1,202 |
$32K |
| K0004 |
High strength ltwt whlchr |
171 |
160 |
$27K |
| E2363 |
Gr24 sealed leadacid battery |
109 |
84 |
$26K |
| E2206 |
Man wc whl lock comp repl ea |
525 |
376 |
$25K |
| E2366 |
Battery charger, single mode |
149 |
123 |
$21K |
| E2219 |
Foam caster tire any size ea |
311 |
232 |
$19K |
| E2386 |
Foam filled drive wheel tire |
106 |
66 |
$17K |
| E0952 |
Toe loop/holder, each |
563 |
433 |
$15K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
48 |
40 |
$14K |
| K0038 |
Leg strap each |
468 |
358 |
$10K |
| E2392 |
Solid caster tire, integrate |
131 |
89 |
$8K |
| E2613 |
Position back cush wd <22in |
28 |
25 |
$8K |
| E2359 |
Gr34 sealed leadacid battery |
31 |
24 |
$6K |
| E2394 |
Drive wheel excludes tire |
82 |
52 |
$6K |
| K0070 |
Rr whl compl pne tire rep ea |
20 |
15 |
$4K |
| E2605 |
Position wc cush wdth <22 in |
14 |
13 |
$3K |
| E2210 |
Wheelchair bearings |
97 |
72 |
$3K |
| E0630 |
Patient lift hydraulic |
49 |
49 |
$3K |
| T4541 |
Large disposable underpad |
28 |
28 |
$2K |
| K0195 |
Elevating whlchair leg rests |
483 |
455 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
25 |
25 |
$1K |
| K0077 |
Fr cstr asmb sol tire rep ea |
12 |
12 |
$1K |
| A4927 |
Non-sterile gloves |
44 |
44 |
$685.08 |
| E2323 |
Special joystick handle |
14 |
12 |
$681.73 |