| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,626 |
2,596 |
$6.01M |
| E1007 |
Pwr seat combo w/shear |
1,286 |
990 |
$5.30M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
1,067 |
825 |
$4.38M |
| K0108 |
W/c component-accessory nos |
17,920 |
10,683 |
$3.68M |
| A4353 |
Intermittent urinary cath |
2,942 |
2,813 |
$3.07M |
| K0005 |
Ultralightweight wheelchair |
1,601 |
1,446 |
$2.50M |
| E2311 |
Electro connect btw 2 sys |
1,863 |
1,436 |
$1.73M |
| E1028 |
W/c manual swingaway |
9,063 |
6,593 |
$1.52M |
| E1161 |
Manual adult wc w tiltinspac |
1,925 |
1,659 |
$1.49M |
| E1012 |
Ctr mount pwr elev leg rest |
1,535 |
1,254 |
$1.28M |
| E8000 |
Posterior gait trainer |
546 |
537 |
$1.05M |
| K0739 |
Repair/svc dme non-oxygen eq |
15,122 |
13,312 |
$833K |
| A4351 |
Straight tip urine catheter |
2,846 |
2,698 |
$761K |
| E2620 |
Wc planar back cush wd <22in |
2,256 |
1,876 |
$628K |
| E0955 |
Cushioned headrest |
5,144 |
4,351 |
$585K |
| E0956 |
W/c lateral trunk/hip suppor |
3,908 |
2,870 |
$450K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,658 |
2,308 |
$448K |
| E2624 |
Adj skin pro/pos cus<22in |
2,003 |
1,664 |
$438K |
| E0973 |
W/ch access det adj armrest |
4,195 |
3,515 |
$388K |
| E1002 |
Pwr seat tilt |
166 |
151 |
$373K |
| E1236 |
Folding ped wc adjustable |
231 |
225 |
$314K |
| K0040 |
Adjustable angle footplate |
3,904 |
3,239 |
$312K |
| E2359 |
Gr34 sealed leadacid battery |
1,397 |
1,164 |
$298K |
| E2377 |
Expandable controller, initl |
1,595 |
1,163 |
$298K |
| E2613 |
Position back cush wd <22in |
1,073 |
932 |
$288K |
| E0240 |
Bath/shower chair |
114 |
113 |
$274K |
| E2300 |
Pwr seat elevation sys |
133 |
108 |
$266K |
| E2617 |
Custom fab w/c back cushion |
355 |
269 |
$258K |
| E2313 |
Pwc harness, expand control |
1,629 |
1,200 |
$229K |
| E0960 |
W/c shoulder harness/straps |
3,214 |
2,744 |
$214K |
| E2361 |
22nf sealed leadacid battery |
1,376 |
1,196 |
$212K |
| E0971 |
Wheelchair anti-tipping devi |
3,963 |
3,485 |
$207K |
| E0953 |
W/c lateral thigh/knee sup |
1,390 |
1,067 |
$135K |
| E2363 |
Gr24 sealed leadacid battery |
699 |
595 |
$127K |
| K0823 |
Pwc gp 2 std cap chair |
81 |
80 |
$124K |
| E0978 |
W/c acc,saf belt pelv strap |
5,840 |
5,039 |
$121K |
| E2231 |
Solid seat support base |
1,057 |
891 |
$119K |
| A4520 |
Incontinence garment anytype |
705 |
682 |
$119K |
| E2392 |
Solid caster tire, integrate |
1,429 |
1,264 |
$119K |
| E2366 |
Battery charger, single mode |
970 |
892 |
$105K |
| E0950 |
Tray |
1,663 |
1,409 |
$104K |
| E2374 |
Hand/chin ctrl std joystick |
420 |
361 |
$103K |
| A4554 |
Disposable underpads |
2,037 |
1,798 |
$99K |
| E2213 |
Pneumatic prop tire insert |
1,978 |
1,723 |
$91K |
| A4352 |
Coude tip urinary catheter |
94 |
93 |
$89K |
| E2386 |
Foam filled drive wheel tire |
733 |
625 |
$86K |
| E2211 |
Pneumatic propulsion tire |
1,250 |
1,121 |
$73K |
| E2622 |
Adj skin pro w/c cus wd<22in |
302 |
269 |
$66K |
| E0951 |
Loop heel |
2,875 |
2,438 |
$62K |
| E0961 |
Wheelchair brake extension |
1,777 |
1,541 |
$62K |
| E2394 |
Drive wheel excludes tire |
826 |
717 |
$57K |
| E2615 |
Pos back post/lat wdth <22in |
160 |
151 |
$55K |
| E2611 |
Gen use back cush wdth <22in |
326 |
293 |
$52K |
| E2206 |
Man wc whl lock comp repl ea |
822 |
642 |
$40K |
| E2203 |
Frame depth less than 22 in |
84 |
72 |
$33K |
| E0986 |
Man w/c powr assist syst |
16 |
12 |
$29K |
| E0990 |
Wheelchair elevating leg res |
212 |
189 |
$28K |
| K0017 |
Detach adjust armrest base |
534 |
464 |
$25K |
| K0019 |
Arm pad repl, each |
1,711 |
1,463 |
$24K |
| K0077 |
Fr cstr asmb sol tire rep ea |
235 |
215 |
$23K |
| K0038 |
Leg strap each |
1,094 |
905 |
$22K |
| A4927 |
Non-sterile gloves |
2,096 |
1,939 |
$21K |
| A4402 |
Lubricant per ounce |
2,122 |
2,028 |
$17K |
| A4314 |
Cath w/drainage 2-way latex |
312 |
300 |
$16K |
| E2298 |
Pwr seat elev sys for crt |
12 |
12 |
$15K |
| E2370 |
Pwr wc dr wh motor/gear comb |
29 |
25 |
$13K |
| A4358 |
Urinary leg or abdomen bag |
1,443 |
1,331 |
$13K |
| E2601 |
Gen w/c cushion wdth < 22 in |
376 |
314 |
$11K |
| E0952 |
Toe loop/holder, each |
348 |
326 |
$11K |
| E0954 |
Foot box, any type each foot |
136 |
115 |
$10K |
| E2365 |
U1 sealed leadacid battery |
96 |
89 |
$9K |
| A4357 |
Bedside drainage bag |
490 |
451 |
$8K |
| K0462 |
Temporary replacement eqpmnt |
48 |
34 |
$7K |
| T4526 |
Adult size pull-on med |
52 |
51 |
$6K |
| E0966 |
Wheelchair head rest extensi |
99 |
83 |
$6K |
| E1225 |
Manual semi-reclining back |
15 |
12 |
$6K |
| E2205 |
Manual wc accessory, handrim |
76 |
70 |
$5K |
| E2603 |
Skin protect wc cus wd <22in |
43 |
39 |
$4K |
| E0944 |
Pelvic belt/harness/boot |
147 |
95 |
$4K |
| K0800 |
Pov group 1 std up to 300lbs |
12 |
12 |
$3K |
| E2619 |
Replace cover w/c seat cush |
46 |
42 |
$2K |
| K0018 |
Detach adjust armrst upper |
28 |
26 |
$1K |
| E2219 |
Foam caster tire any size ea |
19 |
17 |
$905.75 |
| K0043 |
Ftrst lowr exten tube rep ea |
31 |
24 |
$856.43 |
| E2208 |
Cylinder tank carrier |
13 |
12 |
$270.91 |