| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
7,958 |
2,059 |
$6.69M |
| K0108 |
W/c component-accessory nos |
5,507 |
2,715 |
$916K |
| E1028 |
W/c manual swingaway |
3,579 |
2,046 |
$351K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,728 |
2,901 |
$141K |
| E0955 |
Cushioned headrest |
1,944 |
1,496 |
$136K |
| E0960 |
W/c shoulder harness/straps |
1,212 |
873 |
$72K |
| E0973 |
W/ch access det adj armrest |
917 |
634 |
$53K |
| E1161 |
Manual adult wc w tiltinspac |
44 |
38 |
$33K |
| K0040 |
Adjustable angle footplate |
507 |
360 |
$32K |
| E0956 |
W/c lateral trunk/hip suppor |
272 |
156 |
$27K |
| E0971 |
Wheelchair anti-tipping devi |
609 |
469 |
$22K |
| K0005 |
Ultralightweight wheelchair |
16 |
12 |
$19K |
| E0978 |
W/c acc,saf belt pelv strap |
1,198 |
923 |
$19K |
| E2607 |
Skin pro/pos wc cus wd <22in |
117 |
90 |
$19K |
| K0823 |
Pwc gp 2 std cap chair |
18 |
13 |
$7K |
| E0950 |
Tray |
135 |
100 |
$6K |
| E2613 |
Position back cush wd <22in |
17 |
14 |
$4K |
| E2211 |
Pneumatic propulsion tire |
72 |
54 |
$3K |
| E0951 |
Loop heel |
173 |
121 |
$3K |
| E2213 |
Pneumatic prop tire insert |
36 |
25 |
$945.65 |
| E0961 |
Wheelchair brake extension |
16 |
13 |
$411.51 |