| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,600 |
1,410 |
$2.46M |
| K0108 |
W/c component-accessory nos |
9,471 |
3,955 |
$1.93M |
| E0240 |
Bath/shower chair |
582 |
563 |
$1.03M |
| A4353 |
Intermittent urinary cath |
1,484 |
1,392 |
$908K |
| E1028 |
W/c manual swingaway |
7,137 |
3,829 |
$692K |
| E2617 |
Custom fab w/c back cushion |
237 |
213 |
$574K |
| E1161 |
Manual adult wc w tiltinspac |
1,409 |
1,362 |
$573K |
| E2609 |
Custom fabricate w/c cushion |
187 |
170 |
$429K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,497 |
4,940 |
$402K |
| E0955 |
Cushioned headrest |
2,945 |
2,684 |
$243K |
| E2607 |
Skin pro/pos wc cus wd <22in |
786 |
696 |
$226K |
| K0005 |
Ultralightweight wheelchair |
171 |
150 |
$222K |
| A9900 |
Supply/accessory/service |
704 |
84 |
$215K |
| E0973 |
W/ch access det adj armrest |
1,725 |
1,384 |
$191K |
| E0956 |
W/c lateral trunk/hip suppor |
1,508 |
888 |
$190K |
| E2613 |
Position back cush wd <22in |
465 |
404 |
$173K |
| K0040 |
Adjustable angle footplate |
1,589 |
1,320 |
$141K |
| E0950 |
Tray |
1,110 |
945 |
$118K |
| E0960 |
W/c shoulder harness/straps |
1,528 |
1,305 |
$108K |
| E0971 |
Wheelchair anti-tipping devi |
1,485 |
1,258 |
$91K |
| A4351 |
Straight tip urine catheter |
829 |
793 |
$88K |
| 97542 |
|
2,071 |
792 |
$79K |
| E1007 |
Pwr seat combo w/shear |
14 |
13 |
$68K |
| E2213 |
Pneumatic prop tire insert |
1,203 |
1,047 |
$57K |
| E0978 |
W/c acc,saf belt pelv strap |
1,934 |
1,692 |
$55K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
12 |
12 |
$49K |
| A4554 |
Disposable underpads |
1,166 |
1,143 |
$42K |
| E2311 |
Electro connect btw 2 sys |
30 |
26 |
$33K |
| E2211 |
Pneumatic propulsion tire |
555 |
499 |
$29K |
| E2392 |
Solid caster tire, integrate |
264 |
224 |
$23K |
| E2374 |
Hand/chin ctrl std joystick |
71 |
64 |
$21K |
| E2620 |
Wc planar back cush wd <22in |
53 |
42 |
$20K |
| E1012 |
Ctr mount pwr elev leg rest |
37 |
25 |
$20K |
| E0951 |
Loop heel |
862 |
738 |
$19K |
| E0961 |
Wheelchair brake extension |
387 |
337 |
$15K |
| E2377 |
Expandable controller, initl |
49 |
38 |
$12K |
| K0077 |
Fr cstr asmb sol tire rep ea |
125 |
115 |
$10K |
| K0019 |
Arm pad repl, each |
503 |
444 |
$9K |
| E2366 |
Battery charger, single mode |
55 |
55 |
$9K |
| E2313 |
Pwc harness, expand control |
47 |
36 |
$8K |
| E2206 |
Man wc whl lock comp repl ea |
159 |
104 |
$6K |
| E2394 |
Drive wheel excludes tire |
71 |
63 |
$6K |
| A4335 |
Incontinence supply |
885 |
859 |
$6K |
| E2386 |
Foam filled drive wheel tire |
26 |
24 |
$4K |
| E2361 |
22nf sealed leadacid battery |
27 |
25 |
$4K |
| E2624 |
Adj skin pro/pos cus<22in |
12 |
12 |
$3K |
| A4402 |
Lubricant per ounce |
536 |
517 |
$2K |
| A4927 |
Non-sterile gloves |
307 |
288 |
$2K |
| E0952 |
Toe loop/holder, each |
29 |
27 |
$674.92 |
| K0038 |
Leg strap each |
31 |
25 |
$579.28 |
| A4357 |
Bedside drainage bag |
64 |
64 |
$521.28 |