| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,235 |
1,404 |
$3.45M |
| K0108 |
W/c component-accessory nos |
2,958 |
1,896 |
$1.79M |
| E1161 |
Manual adult wc w tiltinspac |
1,121 |
970 |
$246K |
| E1028 |
W/c manual swingaway |
3,516 |
2,190 |
$206K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,056 |
1,638 |
$146K |
| E0955 |
Cushioned headrest |
2,007 |
1,679 |
$72K |
| E0973 |
W/ch access det adj armrest |
467 |
339 |
$46K |
| K0040 |
Adjustable angle footplate |
568 |
449 |
$35K |
| E0956 |
W/c lateral trunk/hip suppor |
166 |
148 |
$33K |
| E0960 |
W/c shoulder harness/straps |
501 |
464 |
$26K |
| E2617 |
Custom fab w/c back cushion |
30 |
26 |
$23K |
| E2609 |
Custom fabricate w/c cushion |
13 |
13 |
$14K |
| E0971 |
Wheelchair anti-tipping devi |
290 |
230 |
$13K |
| E0978 |
W/c acc,saf belt pelv strap |
528 |
480 |
$12K |
| E0950 |
Tray |
178 |
169 |
$11K |
| E0630 |
Patient lift hydraulic |
190 |
132 |
$8K |
| K0823 |
Pwc gp 2 std cap chair |
64 |
59 |
$3K |
| E2620 |
Wc planar back cush wd <22in |
14 |
13 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
13 |
12 |
$2K |
| E0951 |
Loop heel |
77 |
65 |
$2K |
| E0957 |
W/c medial thigh support |
12 |
12 |
$1K |
| E2213 |
Pneumatic prop tire insert |
14 |
12 |
$443.60 |