| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
9,146 |
3,874 |
$4.11M |
| K0108 |
W/c component-accessory nos |
7,915 |
2,862 |
$630K |
| E1028 |
W/c manual swingaway |
8,939 |
5,162 |
$546K |
| E1161 |
Manual adult wc w tiltinspac |
1,431 |
1,209 |
$409K |
| K0823 |
Pwc gp 2 std cap chair |
1,912 |
1,742 |
$283K |
| K0739 |
Repair/svc dme non-oxygen eq |
8,832 |
6,397 |
$241K |
| E0973 |
W/ch access det adj armrest |
2,745 |
1,921 |
$169K |
| E0955 |
Cushioned headrest |
3,247 |
2,533 |
$151K |
| E2617 |
Custom fab w/c back cushion |
198 |
131 |
$150K |
| E0956 |
W/c lateral trunk/hip suppor |
1,181 |
733 |
$114K |
| E0240 |
Bath/shower chair |
84 |
62 |
$110K |
| E1010 |
Add pwr leg elevation |
99 |
81 |
$103K |
| E2609 |
Custom fabricate w/c cushion |
158 |
98 |
$102K |
| E1223 |
Wheelchair spec size w foot |
60 |
52 |
$98K |
| K0040 |
Adjustable angle footplate |
1,487 |
1,053 |
$83K |
| E2361 |
22nf sealed leadacid battery |
782 |
602 |
$75K |
| E1012 |
Ctr mount pwr elev leg rest |
740 |
647 |
$52K |
| E0971 |
Wheelchair anti-tipping devi |
1,218 |
886 |
$51K |
| E0960 |
W/c shoulder harness/straps |
1,001 |
777 |
$50K |
| E2607 |
Skin pro/pos wc cus wd <22in |
431 |
320 |
$43K |
| E2392 |
Solid caster tire, integrate |
872 |
641 |
$40K |
| K0825 |
Pwc gp 2 hd cap chair |
244 |
233 |
$39K |
| E2374 |
Hand/chin ctrl std joystick |
182 |
148 |
$38K |
| E2622 |
Adj skin pro w/c cus wd<22in |
339 |
244 |
$36K |
| E2386 |
Foam filled drive wheel tire |
343 |
269 |
$36K |
| E2620 |
Wc planar back cush wd <22in |
187 |
136 |
$34K |
| E0978 |
W/c acc,saf belt pelv strap |
2,118 |
1,587 |
$33K |
| E2370 |
Pwr wc dr wh motor/gear comb |
56 |
39 |
$21K |
| E2211 |
Pneumatic propulsion tire |
608 |
444 |
$17K |
| E2394 |
Drive wheel excludes tire |
331 |
263 |
$16K |
| E2363 |
Gr24 sealed leadacid battery |
125 |
87 |
$15K |
| E2311 |
Electro connect btw 2 sys |
15 |
13 |
$15K |
| E2366 |
Battery charger, single mode |
63 |
50 |
$6K |
| E0630 |
Patient lift hydraulic |
79 |
78 |
$5K |
| E2365 |
U1 sealed leadacid battery |
56 |
40 |
$4K |
| E0994 |
Wheelchair arm rest |
210 |
185 |
$4K |
| E0951 |
Loop heel |
309 |
208 |
$4K |
| E0950 |
Tray |
91 |
69 |
$3K |
| E2377 |
Expandable controller, initl |
17 |
12 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
99 |
66 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
58 |
54 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
17 |
12 |
$553.13 |
| E2213 |
Pneumatic prop tire insert |
15 |
13 |
$256.89 |
| E0961 |
Wheelchair brake extension |
22 |
13 |
$251.32 |
| E2210 |
Wheelchair bearings |
34 |
24 |
$236.49 |
| K0019 |
Arm pad repl, each |
76 |
67 |
$220.24 |