| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
12,066 |
10,871 |
$9.54M |
| E1007 |
Pwr seat combo w/shear |
1,344 |
1,233 |
$6.45M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
1,073 |
982 |
$3.24M |
| E2311 |
Electro connect btw 2 sys |
2,220 |
2,014 |
$2.82M |
| K0108 |
W/c component-accessory nos |
13,650 |
9,579 |
$2.18M |
| E1002 |
Pwr seat tilt |
650 |
605 |
$1.48M |
| E1028 |
W/c manual swingaway |
17,414 |
14,184 |
$1.48M |
| E1012 |
Ctr mount pwr elev leg rest |
2,337 |
2,076 |
$1.21M |
| E2620 |
Wc planar back cush wd <22in |
4,971 |
4,453 |
$1.21M |
| K0739 |
Repair/svc dme non-oxygen eq |
18,319 |
14,374 |
$1.11M |
| E0955 |
Cushioned headrest |
14,010 |
12,762 |
$1.05M |
| E2622 |
Adj skin pro w/c cus wd<22in |
5,604 |
4,926 |
$983K |
| E0973 |
W/ch access det adj armrest |
7,887 |
6,566 |
$790K |
| E1399 |
Durable medical equipment mi |
736 |
439 |
$672K |
| E2615 |
Pos back post/lat wdth <22in |
2,321 |
2,070 |
$633K |
| E2203 |
Frame depth less than 22 in |
1,889 |
1,723 |
$623K |
| E2231 |
Solid seat support base |
6,195 |
5,532 |
$622K |
| E0956 |
W/c lateral trunk/hip suppor |
5,426 |
3,822 |
$566K |
| E2361 |
22nf sealed leadacid battery |
3,260 |
2,711 |
$432K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,610 |
1,462 |
$407K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,642 |
2,369 |
$397K |
| E2377 |
Expandable controller, initl |
1,512 |
1,391 |
$385K |
| E2300 |
Pwr seat elevation sys |
210 |
178 |
$371K |
| K0040 |
Adjustable angle footplate |
6,355 |
5,080 |
$364K |
| E0990 |
Wheelchair elevating leg res |
2,733 |
2,388 |
$352K |
| E0971 |
Wheelchair anti-tipping devi |
7,249 |
6,105 |
$332K |
| E2313 |
Pwc harness, expand control |
1,519 |
1,397 |
$271K |
| E2213 |
Pneumatic prop tire insert |
6,488 |
5,484 |
$222K |
| E2374 |
Hand/chin ctrl std joystick |
921 |
727 |
$202K |
| E0978 |
W/c acc,saf belt pelv strap |
7,744 |
6,887 |
$170K |
| E2623 |
Adj skin pro wc cus wd>=22in |
590 |
518 |
$143K |
| E0954 |
Foot box, any type each foot |
1,529 |
1,334 |
$127K |
| E2298 |
Pwr seat elev sys for crt |
80 |
75 |
$105K |
| K0835 |
Pwc gp2 std sing pow opt s/b |
79 |
73 |
$89K |
| K0005 |
Ultralightweight wheelchair |
95 |
87 |
$84K |
| E2363 |
Gr24 sealed leadacid battery |
411 |
333 |
$78K |
| E2365 |
U1 sealed leadacid battery |
615 |
528 |
$61K |
| E2366 |
Battery charger, single mode |
485 |
333 |
$42K |
| E0986 |
Man w/c powr assist syst |
41 |
36 |
$41K |
| K0038 |
Leg strap each |
2,398 |
2,155 |
$36K |
| E0950 |
Tray |
533 |
482 |
$32K |
| E2211 |
Pneumatic propulsion tire |
902 |
702 |
$29K |
| E2621 |
Wc planar back cush wd>=22in |
81 |
77 |
$29K |
| E2395 |
Caster wheel excludes tire |
685 |
411 |
$29K |
| K0019 |
Arm pad repl, each |
2,613 |
1,918 |
$28K |
| E2386 |
Foam filled drive wheel tire |
282 |
198 |
$27K |
| E2370 |
Pwr wc dr wh motor/gear comb |
27 |
25 |
$25K |
| E2617 |
Custom fab w/c back cushion |
27 |
25 |
$23K |
| E0961 |
Wheelchair brake extension |
727 |
550 |
$20K |
| E2394 |
Drive wheel excludes tire |
472 |
321 |
$20K |
| E0951 |
Loop heel |
1,100 |
892 |
$18K |
| E0957 |
W/c medial thigh support |
197 |
174 |
$18K |
| E2389 |
Foam caster tire |
544 |
326 |
$13K |
| E2392 |
Solid caster tire, integrate |
313 |
189 |
$13K |
| K0070 |
Rr whl compl pne tire rep ea |
81 |
63 |
$11K |
| E0953 |
W/c lateral thigh/knee sup |
102 |
83 |
$10K |
| K0195 |
Elevating whlchair leg rests |
1,717 |
1,584 |
$5K |
| E2206 |
Man wc whl lock comp repl ea |
163 |
130 |
$5K |
| E2624 |
Adj skin pro/pos cus<22in |
25 |
24 |
$5K |
| E2210 |
Wheelchair bearings |
378 |
275 |
$3K |
| E2608 |
Skin pro/pos wc cus wd>=22in |
12 |
12 |
$2K |
| K0823 |
Pwc gp 2 std cap chair |
18 |
12 |
$2K |
| K0077 |
Fr cstr asmb sol tire rep ea |
31 |
25 |
$2K |
| E0960 |
W/c shoulder harness/straps |
14 |
14 |
$811.91 |
| K0043 |
Ftrst lowr exten tube rep ea |
48 |
37 |
$597.96 |
| E0995 |
Wc calf rest, pad replacemnt |
33 |
25 |
$427.90 |