| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,556 |
339 |
$657K |
| K0108 |
W/c component-accessory nos |
2,785 |
1,018 |
$396K |
| E1028 |
W/c manual swingaway |
2,573 |
1,566 |
$157K |
| T4523 |
Adult size brief/diaper lg |
653 |
636 |
$105K |
| E1161 |
Manual adult wc w tiltinspac |
694 |
544 |
$105K |
| A4554 |
Disposable underpads |
961 |
934 |
$85K |
| K0823 |
Pwc gp 2 std cap chair |
273 |
258 |
$68K |
| A6250 |
Skin seal protect moisturizr |
623 |
607 |
$65K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,590 |
1,268 |
$63K |
| T4524 |
Adult size brief/diaper xl |
337 |
330 |
$59K |
| A4927 |
Non-sterile gloves |
1,736 |
1,697 |
$52K |
| E0973 |
W/ch access det adj armrest |
578 |
414 |
$43K |
| E0955 |
Cushioned headrest |
1,010 |
903 |
$42K |
| K0040 |
Adjustable angle footplate |
420 |
291 |
$19K |
| E0960 |
W/c shoulder harness/straps |
348 |
308 |
$18K |
| E0956 |
W/c lateral trunk/hip suppor |
127 |
89 |
$16K |
| K0005 |
Ultralightweight wheelchair |
22 |
12 |
$15K |
| E2607 |
Skin pro/pos wc cus wd <22in |
108 |
80 |
$13K |
| A5120 |
Skin barrier, wipe or swab |
1,226 |
1,202 |
$12K |
| E0971 |
Wheelchair anti-tipping devi |
282 |
196 |
$10K |
| E0978 |
W/c acc,saf belt pelv strap |
494 |
424 |
$10K |
| E1012 |
Ctr mount pwr elev leg rest |
69 |
52 |
$7K |
| A4928 |
Surgical mask |
401 |
401 |
$5K |
| E2361 |
22nf sealed leadacid battery |
33 |
29 |
$4K |
| E2613 |
Position back cush wd <22in |
23 |
15 |
$3K |
| E2620 |
Wc planar back cush wd <22in |
17 |
13 |
$3K |
| E2211 |
Pneumatic propulsion tire |
38 |
25 |
$1K |
| T4535 |
Disposable liner/shield/pad |
17 |
12 |
$358.50 |
| E0951 |
Loop heel |
16 |
13 |
$311.22 |