| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
10,049 |
6,641 |
$2.03M |
| E1399 |
Durable medical equipment mi |
2,408 |
1,887 |
$1.18M |
| E0240 |
Bath/shower chair |
649 |
619 |
$884K |
| E1028 |
W/c manual swingaway |
2,997 |
2,343 |
$524K |
| K0739 |
Repair/svc dme non-oxygen eq |
8,903 |
8,511 |
$361K |
| E2617 |
Custom fab w/c back cushion |
327 |
321 |
$342K |
| E2609 |
Custom fabricate w/c cushion |
326 |
314 |
$229K |
| E0973 |
W/ch access det adj armrest |
1,588 |
1,328 |
$172K |
| E0956 |
W/c lateral trunk/hip suppor |
885 |
772 |
$139K |
| K0040 |
Adjustable angle footplate |
1,299 |
1,150 |
$120K |
| E0955 |
Cushioned headrest |
1,269 |
1,207 |
$98K |
| E0960 |
W/c shoulder harness/straps |
1,091 |
969 |
$73K |
| E0971 |
Wheelchair anti-tipping devi |
1,236 |
1,103 |
$72K |
| E1161 |
Manual adult wc w tiltinspac |
185 |
183 |
$65K |
| E2361 |
22nf sealed leadacid battery |
150 |
148 |
$26K |
| E2613 |
Position back cush wd <22in |
73 |
51 |
$24K |
| K0823 |
Pwc gp 2 std cap chair |
12 |
12 |
$18K |
| E2213 |
Pneumatic prop tire insert |
440 |
429 |
$18K |
| K0800 |
Pov group 1 std up to 300lbs |
12 |
12 |
$15K |
| E0978 |
W/c acc,saf belt pelv strap |
495 |
488 |
$10K |
| E2624 |
Adj skin pro/pos cus<22in |
24 |
24 |
$5K |
| E0950 |
Tray |
50 |
37 |
$4K |
| E2622 |
Adj skin pro w/c cus wd<22in |
13 |
13 |
$3K |
| E2365 |
U1 sealed leadacid battery |
38 |
37 |
$2K |
| E0951 |
Loop heel |
100 |
92 |
$2K |
| K0077 |
Fr cstr asmb sol tire rep ea |
27 |
27 |
$1K |
| E0957 |
W/c medial thigh support |
13 |
13 |
$1K |
| K0019 |
Arm pad repl, each |
43 |
40 |
$746.30 |