| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
613 |
210 |
$867K |
| K0108 |
W/c component-accessory nos |
5,844 |
2,839 |
$832K |
| E1028 |
W/c manual swingaway |
4,677 |
2,822 |
$359K |
| E1161 |
Manual adult wc w tiltinspac |
512 |
414 |
$211K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,876 |
3,782 |
$172K |
| E0955 |
Cushioned headrest |
2,005 |
1,614 |
$136K |
| E0973 |
W/ch access det adj armrest |
1,436 |
1,014 |
$111K |
| K0823 |
Pwc gp 2 std cap chair |
562 |
533 |
$105K |
| E2609 |
Custom fabricate w/c cushion |
115 |
103 |
$91K |
| E2617 |
Custom fab w/c back cushion |
86 |
67 |
$74K |
| E0960 |
W/c shoulder harness/straps |
737 |
503 |
$40K |
| E0978 |
W/c acc,saf belt pelv strap |
1,393 |
1,060 |
$30K |
| K0040 |
Adjustable angle footplate |
440 |
320 |
$30K |
| E0956 |
W/c lateral trunk/hip suppor |
300 |
177 |
$27K |
| E0971 |
Wheelchair anti-tipping devi |
591 |
443 |
$25K |
| E2361 |
22nf sealed leadacid battery |
165 |
132 |
$16K |
| E2392 |
Solid caster tire, integrate |
178 |
141 |
$11K |
| K0004 |
High strength ltwt whlchr |
65 |
61 |
$5K |
| K0825 |
Pwc gp 2 hd cap chair |
13 |
12 |
$5K |
| E0951 |
Loop heel |
233 |
175 |
$5K |
| E2386 |
Foam filled drive wheel tire |
37 |
32 |
$4K |
| E0950 |
Tray |
79 |
52 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
20 |
14 |
$3K |
| E2394 |
Drive wheel excludes tire |
36 |
32 |
$3K |
| E2374 |
Hand/chin ctrl std joystick |
15 |
12 |
$2K |
| K0019 |
Arm pad repl, each |
163 |
117 |
$2K |
| E2213 |
Pneumatic prop tire insert |
13 |
13 |
$563.43 |
| E2211 |
Pneumatic propulsion tire |
16 |
13 |
$553.31 |