| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
7,298 |
2,092 |
$6.19M |
| E1220 |
Whlchr special size/constrc |
1,707 |
967 |
$3.67M |
| K0108 |
W/c component-accessory nos |
4,286 |
1,064 |
$2.09M |
| K0005 |
Ultralightweight wheelchair |
98 |
80 |
$124K |
| E0973 |
W/ch access det adj armrest |
1,221 |
751 |
$78K |
| K0004 |
High strength ltwt whlchr |
725 |
665 |
$68K |
| E1028 |
W/c manual swingaway |
974 |
473 |
$49K |
| K0040 |
Adjustable angle footplate |
963 |
604 |
$44K |
| E0971 |
Wheelchair anti-tipping devi |
1,262 |
784 |
$43K |
| E2607 |
Skin pro/pos wc cus wd <22in |
385 |
254 |
$42K |
| E1161 |
Manual adult wc w tiltinspac |
41 |
26 |
$33K |
| E0978 |
W/c acc,saf belt pelv strap |
1,352 |
941 |
$23K |
| E0260 |
Hosp bed semi-electr w/ matt |
85 |
77 |
$12K |
| E0955 |
Cushioned headrest |
371 |
242 |
$11K |
| E0240 |
Bath/shower chair |
20 |
12 |
$10K |
| E0630 |
Patient lift hydraulic |
72 |
63 |
$9K |
| E2613 |
Position back cush wd <22in |
30 |
25 |
$5K |
| K0739 |
Repair/svc dme non-oxygen eq |
338 |
230 |
$5K |
| E0951 |
Loop heel |
372 |
231 |
$5K |
| E0165 |
Commode chair with detacharm |
63 |
52 |
$2K |
| E8000 |
Posterior gait trainer |
42 |
12 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
29 |
12 |
$991.40 |
| E2601 |
Gen w/c cushion wdth < 22 in |
26 |
25 |
$829.27 |
| E0950 |
Tray |
20 |
12 |
$718.04 |
| K0038 |
Leg strap each |
15 |
15 |
$214.94 |