| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
19,378 |
4,912 |
$15.15M |
| K0108 |
W/c component-accessory nos |
17,102 |
7,873 |
$3.60M |
| E1161 |
Manual adult wc w tiltinspac |
4,526 |
4,322 |
$1.12M |
| E1236 |
Folding ped wc adjustable |
956 |
868 |
$923K |
| K0005 |
Ultralightweight wheelchair |
950 |
868 |
$917K |
| E1028 |
W/c manual swingaway |
10,738 |
8,117 |
$874K |
| K0739 |
Repair/svc dme non-oxygen eq |
9,020 |
8,235 |
$650K |
| E1007 |
Pwr seat combo w/shear |
234 |
210 |
$636K |
| E2617 |
Custom fab w/c back cushion |
740 |
641 |
$554K |
| E2311 |
Electro connect btw 2 sys |
495 |
445 |
$365K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
191 |
177 |
$348K |
| E0955 |
Cushioned headrest |
7,243 |
6,812 |
$344K |
| E2609 |
Custom fabricate w/c cushion |
360 |
325 |
$307K |
| E0973 |
W/ch access det adj armrest |
3,909 |
3,135 |
$287K |
| K0040 |
Adjustable angle footplate |
3,963 |
3,200 |
$254K |
| E0956 |
W/c lateral trunk/hip suppor |
2,427 |
1,836 |
$241K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,741 |
1,602 |
$230K |
| E2620 |
Wc planar back cush wd <22in |
1,020 |
928 |
$221K |
| E0960 |
W/c shoulder harness/straps |
3,541 |
3,253 |
$183K |
| E1012 |
Ctr mount pwr elev leg rest |
318 |
287 |
$128K |
| E0971 |
Wheelchair anti-tipping devi |
3,477 |
2,806 |
$126K |
| E2613 |
Position back cush wd <22in |
615 |
548 |
$117K |
| E2361 |
22nf sealed leadacid battery |
1,120 |
1,013 |
$106K |
| E0978 |
W/c acc,saf belt pelv strap |
4,382 |
4,048 |
$105K |
| E1232 |
Folding ped wc tilt-in-space |
66 |
65 |
$102K |
| E2622 |
Adj skin pro w/c cus wd<22in |
808 |
724 |
$100K |
| E0950 |
Tray |
1,488 |
1,352 |
$85K |
| E2377 |
Expandable controller, initl |
408 |
372 |
$71K |
| E0986 |
Man w/c powr assist syst |
50 |
48 |
$69K |
| E2313 |
Pwc harness, expand control |
425 |
389 |
$59K |
| K0823 |
Pwc gp 2 std cap chair |
311 |
266 |
$58K |
| E0630 |
Patient lift hydraulic |
421 |
394 |
$57K |
| E2213 |
Pneumatic prop tire insert |
1,837 |
1,416 |
$47K |
| E2300 |
Pwr seat elevation sys |
31 |
28 |
$44K |
| E2231 |
Solid seat support base |
651 |
581 |
$43K |
| E2211 |
Pneumatic propulsion tire |
1,715 |
1,307 |
$42K |
| E2615 |
Pos back post/lat wdth <22in |
217 |
196 |
$41K |
| E0966 |
Wheelchair head rest extensi |
892 |
822 |
$32K |
| E0951 |
Loop heel |
2,328 |
1,766 |
$31K |
| E0637 |
Combination sit to stand sys |
12 |
12 |
$28K |
| E2203 |
Frame depth less than 22 in |
109 |
94 |
$25K |
| K0821 |
Pwc gp 2 std port cap chair |
39 |
39 |
$25K |
| E0961 |
Wheelchair brake extension |
1,218 |
964 |
$23K |
| E2219 |
Foam caster tire any size ea |
866 |
666 |
$22K |
| E0952 |
Toe loop/holder, each |
752 |
601 |
$11K |
| E8000 |
Posterior gait trainer |
12 |
12 |
$9K |
| E2298 |
Pwr seat elev sys for crt |
20 |
15 |
$7K |
| K0019 |
Arm pad repl, each |
639 |
533 |
$7K |
| K0038 |
Leg strap each |
417 |
391 |
$7K |
| E2206 |
Man wc whl lock comp repl ea |
205 |
176 |
$5K |
| E2374 |
Hand/chin ctrl std joystick |
28 |
26 |
$5K |
| E0957 |
W/c medial thigh support |
58 |
50 |
$4K |
| K0077 |
Fr cstr asmb sol tire rep ea |
80 |
64 |
$4K |
| E1225 |
Manual semi-reclining back |
24 |
24 |
$4K |
| E2624 |
Adj skin pro/pos cus<22in |
26 |
24 |
$3K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
13 |
12 |
$3K |
| E2366 |
Battery charger, single mode |
19 |
13 |
$959.40 |
| E2395 |
Caster wheel excludes tire |
14 |
12 |
$862.92 |
| K0195 |
Elevating whlchair leg rests |
78 |
78 |
$814.63 |
| E0953 |
W/c lateral thigh/knee sup |
20 |
14 |
$805.08 |
| E2389 |
Foam caster tire |
13 |
12 |
$497.58 |
| E0954 |
Foot box, any type each foot |
20 |
12 |
$461.02 |
| E2210 |
Wheelchair bearings |
39 |
38 |
$318.09 |
| K0043 |
Ftrst lowr exten tube rep ea |
18 |
12 |
$196.17 |
| E2619 |
Replace cover w/c seat cush |
13 |
12 |
$112.36 |
| E0995 |
Wc calf rest, pad replacemnt |
14 |
12 |
$66.65 |