| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
13,981 |
4,885 |
$8.36M |
| K0108 |
W/c component-accessory nos |
11,092 |
4,611 |
$3.84M |
| E1028 |
W/c manual swingaway |
11,213 |
6,098 |
$1.04M |
| E1161 |
Manual adult wc w tiltinspac |
1,674 |
1,282 |
$637K |
| E1007 |
Pwr seat combo w/shear |
151 |
102 |
$500K |
| E2617 |
Custom fab w/c back cushion |
1,018 |
585 |
$412K |
| E2311 |
Electro connect btw 2 sys |
406 |
273 |
$397K |
| E0240 |
Bath/shower chair |
639 |
321 |
$371K |
| E0955 |
Cushioned headrest |
4,803 |
3,514 |
$327K |
| E0973 |
W/ch access det adj armrest |
3,864 |
2,710 |
$316K |
| E0956 |
W/c lateral trunk/hip suppor |
3,001 |
1,719 |
$308K |
| E1012 |
Ctr mount pwr elev leg rest |
2,582 |
2,059 |
$274K |
| K0823 |
Pwc gp 2 std cap chair |
1,720 |
1,461 |
$273K |
| K0739 |
Repair/svc dme non-oxygen eq |
9,169 |
6,192 |
$262K |
| K0040 |
Adjustable angle footplate |
3,624 |
2,550 |
$244K |
| E2361 |
22nf sealed leadacid battery |
1,837 |
1,321 |
$212K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,703 |
1,322 |
$205K |
| E1236 |
Folding ped wc adjustable |
150 |
119 |
$158K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
71 |
50 |
$157K |
| E0960 |
W/c shoulder harness/straps |
3,133 |
2,440 |
$156K |
| E0971 |
Wheelchair anti-tipping devi |
2,969 |
2,091 |
$140K |
| E2211 |
Pneumatic propulsion tire |
2,217 |
1,595 |
$83K |
| K0825 |
Pwc gp 2 hd cap chair |
83 |
75 |
$79K |
| E0978 |
W/c acc,saf belt pelv strap |
4,324 |
3,284 |
$78K |
| E0329 |
Ped hospital bed semi/elect |
14 |
13 |
$73K |
| E0950 |
Tray |
1,435 |
1,057 |
$72K |
| E2620 |
Wc planar back cush wd <22in |
252 |
181 |
$55K |
| E1223 |
Wheelchair spec size w foot |
29 |
24 |
$52K |
| E2609 |
Custom fabricate w/c cushion |
211 |
119 |
$50K |
| E2622 |
Adj skin pro w/c cus wd<22in |
352 |
241 |
$45K |
| E2377 |
Expandable controller, initl |
259 |
172 |
$45K |
| E0957 |
W/c medial thigh support |
488 |
374 |
$38K |
| E1235 |
Rigid ped wc adjustable |
13 |
12 |
$25K |
| E0961 |
Wheelchair brake extension |
1,018 |
722 |
$21K |
| E2613 |
Position back cush wd <22in |
92 |
78 |
$19K |
| E2386 |
Foam filled drive wheel tire |
172 |
94 |
$16K |
| E2219 |
Foam caster tire any size ea |
382 |
254 |
$15K |
| E0951 |
Loop heel |
823 |
540 |
$11K |
| E8000 |
Posterior gait trainer |
32 |
12 |
$11K |
| E0994 |
Wheelchair arm rest |
508 |
412 |
$10K |
| E2293 |
Contour back for ped size wc |
18 |
12 |
$6K |
| E2231 |
Solid seat support base |
66 |
54 |
$6K |
| E0966 |
Wheelchair head rest extensi |
122 |
98 |
$6K |
| E2392 |
Solid caster tire, integrate |
112 |
55 |
$5K |
| E2394 |
Drive wheel excludes tire |
137 |
70 |
$5K |
| E0630 |
Patient lift hydraulic |
38 |
24 |
$3K |
| E2365 |
U1 sealed leadacid battery |
31 |
28 |
$3K |
| E0995 |
Wc calf rest, pad replacemnt |
477 |
365 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
24 |
13 |
$2K |
| E2313 |
Pwc harness, expand control |
35 |
25 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
46 |
25 |
$2K |
| E2395 |
Caster wheel excludes tire |
23 |
14 |
$1K |
| K0043 |
Ftrst lowr exten tube rep ea |
153 |
128 |
$776.07 |
| K0019 |
Arm pad repl, each |
95 |
39 |
$356.65 |