| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,894 |
1,403 |
$2.85M |
| K0108 |
W/c component-accessory nos |
6,011 |
2,726 |
$1.05M |
| E1028 |
W/c manual swingaway |
4,431 |
2,794 |
$420K |
| E1161 |
Manual adult wc w tiltinspac |
617 |
402 |
$240K |
| E0973 |
W/ch access det adj armrest |
1,284 |
1,077 |
$153K |
| E0956 |
W/c lateral trunk/hip suppor |
655 |
498 |
$94K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,032 |
2,563 |
$84K |
| K0823 |
Pwc gp 2 std cap chair |
606 |
505 |
$52K |
| E0971 |
Wheelchair anti-tipping devi |
969 |
827 |
$51K |
| K0040 |
Adjustable angle footplate |
602 |
482 |
$50K |
| E0960 |
W/c shoulder harness/straps |
739 |
638 |
$48K |
| E0978 |
W/c acc,saf belt pelv strap |
1,204 |
1,034 |
$31K |
| E2211 |
Pneumatic propulsion tire |
499 |
422 |
$25K |
| E0950 |
Tray |
329 |
279 |
$24K |
| E2311 |
Electro connect btw 2 sys |
19 |
12 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
45 |
38 |
$7K |
| K0004 |
High strength ltwt whlchr |
113 |
93 |
$4K |
| E2231 |
Solid seat support base |
26 |
26 |
$3K |
| E0955 |
Cushioned headrest |
489 |
373 |
$3K |
| E2620 |
Wc planar back cush wd <22in |
13 |
12 |
$3K |
| K0821 |
Pwc gp 2 std port cap chair |
32 |
29 |
$3K |
| W4132 |
|
139 |
132 |
$592.35 |
| E0951 |
Loop heel |
14 |
12 |
$192.48 |
| K0019 |
Arm pad repl, each |
16 |
14 |
$168.62 |