| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
10,333 |
2,299 |
$12.65M |
| K0108 |
W/c component-accessory nos |
3,786 |
700 |
$878K |
| E0641 |
Multi-position stnd fram sys |
41 |
39 |
$228K |
| E1236 |
Folding ped wc adjustable |
103 |
100 |
$129K |
| E2609 |
Custom fabricate w/c cushion |
75 |
60 |
$92K |
| E1028 |
W/c manual swingaway |
604 |
192 |
$79K |
| E2617 |
Custom fab w/c back cushion |
55 |
46 |
$73K |
| T5001 |
Position seat spec orth need |
73 |
62 |
$62K |
| E0955 |
Cushioned headrest |
313 |
250 |
$47K |
| E0960 |
W/c shoulder harness/straps |
446 |
357 |
$28K |
| E8000 |
Posterior gait trainer |
13 |
12 |
$25K |
| K0040 |
Adjustable angle footplate |
323 |
229 |
$20K |
| E0956 |
W/c lateral trunk/hip suppor |
247 |
87 |
$17K |
| E0978 |
W/c acc,saf belt pelv strap |
393 |
343 |
$9K |
| E0950 |
Tray |
105 |
72 |
$7K |
| K0739 |
Repair/svc dme non-oxygen eq |
215 |
185 |
$7K |
| E0240 |
Bath/shower chair |
16 |
13 |
$6K |
| T5999 |
Supply, nos |
204 |
200 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
29 |
12 |
$953.16 |
| E0951 |
Loop heel |
39 |
25 |
$639.30 |
| E0952 |
Toe loop/holder, each |
13 |
12 |
$421.20 |
| A4554 |
Disposable underpads |
12 |
12 |
$397.28 |