| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
7,695 |
2,254 |
$5.29M |
| K0108 |
W/c component-accessory nos |
12,617 |
5,332 |
$2.30M |
| E1028 |
W/c manual swingaway |
8,809 |
6,023 |
$989K |
| E1161 |
Manual adult wc w tiltinspac |
3,046 |
2,734 |
$912K |
| K0005 |
Ultralightweight wheelchair |
593 |
498 |
$673K |
| E2617 |
Custom fab w/c back cushion |
428 |
302 |
$409K |
| E0973 |
W/ch access det adj armrest |
3,465 |
2,687 |
$366K |
| E1235 |
Rigid ped wc adjustable |
747 |
695 |
$328K |
| E0955 |
Cushioned headrest |
5,313 |
4,498 |
$321K |
| E2609 |
Custom fabricate w/c cushion |
335 |
235 |
$295K |
| K0739 |
Repair/svc dme non-oxygen eq |
6,654 |
5,306 |
$250K |
| E0956 |
W/c lateral trunk/hip suppor |
2,137 |
1,439 |
$242K |
| E2613 |
Position back cush wd <22in |
829 |
677 |
$213K |
| K0040 |
Adjustable angle footplate |
2,894 |
2,235 |
$205K |
| E0240 |
Bath/shower chair |
204 |
124 |
$171K |
| E2311 |
Electro connect btw 2 sys |
195 |
136 |
$169K |
| K0823 |
Pwc gp 2 std cap chair |
340 |
259 |
$148K |
| E0971 |
Wheelchair anti-tipping devi |
2,790 |
2,185 |
$142K |
| E0986 |
Man w/c powr assist syst |
95 |
89 |
$138K |
| E0950 |
Tray |
2,349 |
1,844 |
$135K |
| E0960 |
W/c shoulder harness/straps |
2,178 |
1,789 |
$128K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
49 |
38 |
$125K |
| E2607 |
Skin pro/pos wc cus wd <22in |
795 |
593 |
$123K |
| E1012 |
Ctr mount pwr elev leg rest |
138 |
93 |
$119K |
| E2361 |
22nf sealed leadacid battery |
704 |
541 |
$92K |
| E0978 |
W/c acc,saf belt pelv strap |
3,176 |
2,661 |
$80K |
| E2213 |
Pneumatic prop tire insert |
1,894 |
1,469 |
$67K |
| E2211 |
Pneumatic propulsion tire |
1,587 |
1,218 |
$62K |
| K0800 |
Pov group 1 std up to 300lbs |
117 |
108 |
$40K |
| E2620 |
Wc planar back cush wd <22in |
119 |
104 |
$36K |
| E0961 |
Wheelchair brake extension |
1,190 |
912 |
$35K |
| T4523 |
Adult size brief/diaper lg |
389 |
319 |
$35K |
| E0260 |
Hosp bed semi-electr w/ matt |
128 |
118 |
$30K |
| E2231 |
Solid seat support base |
379 |
307 |
$30K |
| E2622 |
Adj skin pro w/c cus wd<22in |
131 |
121 |
$27K |
| E2365 |
U1 sealed leadacid battery |
300 |
231 |
$25K |
| T4522 |
Adult size brief/diaper med |
322 |
252 |
$24K |
| E0951 |
Loop heel |
1,939 |
1,006 |
$23K |
| E2601 |
Gen w/c cushion wdth < 22 in |
543 |
489 |
$22K |
| T4541 |
Large disposable underpad |
442 |
386 |
$14K |
| E2313 |
Pwc harness, expand control |
66 |
49 |
$13K |
| E2377 |
Expandable controller, initl |
65 |
51 |
$12K |
| K0019 |
Arm pad repl, each |
715 |
541 |
$9K |
| E2219 |
Foam caster tire any size ea |
161 |
118 |
$7K |
| E1236 |
Folding ped wc adjustable |
15 |
14 |
$6K |
| K0038 |
Leg strap each |
235 |
207 |
$5K |
| E2624 |
Adj skin pro/pos cus<22in |
29 |
25 |
$4K |
| A4927 |
Non-sterile gloves |
347 |
289 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
27 |
12 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
17 |
16 |
$3K |
| E2366 |
Battery charger, single mode |
13 |
13 |
$2K |
| E0952 |
Toe loop/holder, each |
59 |
45 |
$986.43 |
| E0992 |
Wheelchair solid seat insert |
127 |
121 |
$710.69 |
| K0039 |
Leg strap h style each |
15 |
13 |
$511.30 |