| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
6,826 |
2,369 |
$1.15M |
| K0739 |
Repair/svc dme non-oxygen eq |
5,169 |
4,476 |
$261K |
| E1007 |
Pwr seat combo w/shear |
41 |
37 |
$217K |
| K0005 |
Ultralightweight wheelchair |
101 |
98 |
$185K |
| E1028 |
W/c manual swingaway |
1,611 |
1,084 |
$179K |
| E2311 |
Electro connect btw 2 sys |
72 |
67 |
$115K |
| E1161 |
Manual adult wc w tiltinspac |
170 |
166 |
$91K |
| T4541 |
Large disposable underpad |
1,816 |
1,769 |
$81K |
| E0955 |
Cushioned headrest |
657 |
629 |
$52K |
| E1012 |
Ctr mount pwr elev leg rest |
58 |
54 |
$45K |
| E0973 |
W/ch access det adj armrest |
452 |
362 |
$44K |
| K0040 |
Adjustable angle footplate |
488 |
388 |
$39K |
| E0601 |
Cont airway pressure device |
1,205 |
1,130 |
$37K |
| E2607 |
Skin pro/pos wc cus wd <22in |
165 |
153 |
$32K |
| A4927 |
Non-sterile gloves |
1,026 |
990 |
$21K |
| T4534 |
Youth size pull-on |
162 |
158 |
$21K |
| E2363 |
Gr24 sealed leadacid battery |
77 |
71 |
$20K |
| T4522 |
Adult size brief/diaper med |
102 |
98 |
$18K |
| E2298 |
Pwr seat elev sys for crt |
12 |
12 |
$17K |
| T2029 |
Special med equip, noswaiver |
27 |
24 |
$17K |
| E2377 |
Expandable controller, initl |
56 |
52 |
$16K |
| E2620 |
Wc planar back cush wd <22in |
41 |
40 |
$16K |
| E0971 |
Wheelchair anti-tipping devi |
320 |
257 |
$15K |
| E2213 |
Pneumatic prop tire insert |
358 |
286 |
$15K |
| E2313 |
Pwc harness, expand control |
55 |
52 |
$12K |
| E0562 |
Humidifier heated used w pap |
1,174 |
1,111 |
$11K |
| A4604 |
Tubing with heating element |
183 |
179 |
$7K |
| T4535 |
Disposable liner/shield/pad |
65 |
63 |
$6K |
| A7031 |
Replacement facemask interfa |
140 |
136 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
205 |
192 |
$5K |
| E0961 |
Wheelchair brake extension |
122 |
99 |
$4K |
| E0951 |
Loop heel |
226 |
167 |
$4K |
| E2613 |
Position back cush wd <22in |
14 |
12 |
$4K |
| A7038 |
Pos airway pressure filter |
934 |
915 |
$4K |
| T4528 |
Adult size pull-on xl |
25 |
24 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
51 |
50 |
$3K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$2K |
| E0960 |
W/c shoulder harness/straps |
29 |
27 |
$2K |
| A7035 |
Pos airway press headgear |
96 |
93 |
$2K |
| A7030 |
Cpap full face mask |
12 |
12 |
$1K |
| A7046 |
Repl water chamber, pap dev |
25 |
25 |
$336.86 |