| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
8,818 |
8,776 |
$2.30M |
| E1399 |
Durable medical equipment mi |
1,083 |
1,013 |
$2.29M |
| K0739 |
Repair/svc dme non-oxygen eq |
9,810 |
9,548 |
$2.17M |
| K0108 |
W/c component-accessory nos |
6,751 |
5,433 |
$1.96M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
402 |
399 |
$1.82M |
| E1007 |
Pwr seat combo w/shear |
180 |
180 |
$949K |
| K0005 |
Ultralightweight wheelchair |
532 |
521 |
$588K |
| E2361 |
22nf sealed leadacid battery |
1,555 |
1,534 |
$453K |
| E2620 |
Wc planar back cush wd <22in |
1,561 |
1,525 |
$420K |
| E2617 |
Custom fab w/c back cushion |
473 |
471 |
$417K |
| E2311 |
Electro connect btw 2 sys |
438 |
435 |
$413K |
| E0955 |
Cushioned headrest |
10,335 |
10,264 |
$374K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,776 |
1,728 |
$292K |
| E1012 |
Ctr mount pwr elev leg rest |
368 |
366 |
$284K |
| E1028 |
W/c manual swingaway |
11,087 |
8,780 |
$265K |
| K0856 |
Pwc gp3 std sing pow opt s/b |
98 |
92 |
$263K |
| E0956 |
W/c lateral trunk/hip suppor |
2,132 |
1,609 |
$248K |
| K0040 |
Adjustable angle footplate |
3,569 |
2,735 |
$231K |
| E0960 |
W/c shoulder harness/straps |
2,615 |
2,576 |
$144K |
| E0971 |
Wheelchair anti-tipping devi |
3,306 |
2,500 |
$132K |
| E1002 |
Pwr seat tilt |
69 |
68 |
$122K |
| E2392 |
Solid caster tire, integrate |
776 |
657 |
$95K |
| E2609 |
Custom fabricate w/c cushion |
110 |
109 |
$94K |
| E2300 |
Pwr seat elevation sys |
57 |
56 |
$85K |
| E2213 |
Pneumatic prop tire insert |
2,627 |
2,001 |
$81K |
| E2377 |
Expandable controller, initl |
273 |
272 |
$80K |
| E0973 |
W/ch access det adj armrest |
1,918 |
1,324 |
$77K |
| E2298 |
Pwr seat elev sys for crt |
45 |
43 |
$62K |
| E2313 |
Pwc harness, expand control |
304 |
300 |
$60K |
| K0019 |
Arm pad repl, each |
1,789 |
1,470 |
$51K |
| E0950 |
Tray |
409 |
407 |
$45K |
| E0951 |
Loop heel |
2,447 |
1,790 |
$38K |
| E2386 |
Foam filled drive wheel tire |
216 |
186 |
$30K |
| E0978 |
W/c acc,saf belt pelv strap |
1,635 |
1,624 |
$28K |
| E2211 |
Pneumatic propulsion tire |
1,152 |
828 |
$28K |
| E2374 |
Hand/chin ctrl std joystick |
95 |
95 |
$28K |
| E2615 |
Pos back post/lat wdth <22in |
92 |
92 |
$28K |
| E2206 |
Man wc whl lock comp repl ea |
646 |
491 |
$25K |
| E2624 |
Adj skin pro/pos cus<22in |
125 |
122 |
$24K |
| E2231 |
Solid seat support base |
329 |
329 |
$20K |
| E2622 |
Adj skin pro w/c cus wd<22in |
94 |
94 |
$19K |
| E0953 |
W/c lateral thigh/knee sup |
155 |
120 |
$11K |
| K0077 |
Fr cstr asmb sol tire rep ea |
238 |
193 |
$10K |
| E2363 |
Gr24 sealed leadacid battery |
27 |
27 |
$4K |
| E0961 |
Wheelchair brake extension |
205 |
157 |
$4K |
| K0038 |
Leg strap each |
258 |
249 |
$4K |
| E0957 |
W/c medial thigh support |
39 |
39 |
$4K |
| A9270 |
Non-covered item or service |
43 |
43 |
$4K |
| E2394 |
Drive wheel excludes tire |
36 |
29 |
$2K |
| E2395 |
Caster wheel excludes tire |
13 |
12 |
$1K |
| E2210 |
Wheelchair bearings |
94 |
93 |
$1K |
| E0952 |
Toe loop/holder, each |
71 |
49 |
$831.42 |
| E2389 |
Foam caster tire |
16 |
12 |
$626.65 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$35.31 |