| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
9,172 |
2,083 |
$4.41M |
| K0108 |
W/c component-accessory nos |
11,959 |
5,612 |
$2.07M |
| E1007 |
Pwr seat combo w/shear |
387 |
360 |
$1.41M |
| E1161 |
Manual adult wc w tiltinspac |
3,993 |
3,545 |
$1.36M |
| S9999 |
Sales tax |
5,115 |
4,575 |
$1.30M |
| E1028 |
W/c manual swingaway |
13,272 |
8,093 |
$976K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
325 |
303 |
$895K |
| K0005 |
Ultralightweight wheelchair |
676 |
639 |
$873K |
| E2311 |
Electro connect btw 2 sys |
695 |
630 |
$710K |
| K0739 |
Repair/svc dme non-oxygen eq |
9,175 |
8,459 |
$603K |
| E2620 |
Wc planar back cush wd <22in |
1,884 |
1,748 |
$508K |
| E0973 |
W/ch access det adj armrest |
3,517 |
2,910 |
$309K |
| E1012 |
Ctr mount pwr elev leg rest |
617 |
575 |
$303K |
| E0955 |
Cushioned headrest |
5,697 |
5,140 |
$296K |
| K0823 |
Pwc gp 2 std cap chair |
1,891 |
1,739 |
$292K |
| E0240 |
Bath/shower chair |
129 |
116 |
$212K |
| E2624 |
Adj skin pro/pos cus<22in |
998 |
950 |
$177K |
| E0956 |
W/c lateral trunk/hip suppor |
1,837 |
1,369 |
$162K |
| E0971 |
Wheelchair anti-tipping devi |
2,805 |
2,492 |
$147K |
| A4353 |
Intermittent urinary cath |
198 |
173 |
$146K |
| E2363 |
Gr24 sealed leadacid battery |
893 |
832 |
$139K |
| K0040 |
Adjustable angle footplate |
1,881 |
1,590 |
$137K |
| E2231 |
Solid seat support base |
1,252 |
1,154 |
$130K |
| E2377 |
Expandable controller, initl |
547 |
501 |
$119K |
| E2607 |
Skin pro/pos wc cus wd <22in |
685 |
647 |
$107K |
| E2392 |
Solid caster tire, integrate |
1,520 |
1,355 |
$101K |
| E2313 |
Pwc harness, expand control |
563 |
516 |
$93K |
| E2361 |
22nf sealed leadacid battery |
780 |
726 |
$91K |
| E0986 |
Man w/c powr assist syst |
65 |
61 |
$80K |
| E0960 |
W/c shoulder harness/straps |
1,190 |
1,108 |
$70K |
| E2374 |
Hand/chin ctrl std joystick |
312 |
295 |
$67K |
| K0003 |
Lightweight wheelchair |
528 |
519 |
$63K |
| E0978 |
W/c acc,saf belt pelv strap |
2,659 |
2,511 |
$63K |
| E2386 |
Foam filled drive wheel tire |
606 |
550 |
$62K |
| E2622 |
Adj skin pro w/c cus wd<22in |
346 |
316 |
$61K |
| E2300 |
Pwr seat elevation sys |
27 |
24 |
$52K |
| E2617 |
Custom fab w/c back cushion |
28 |
24 |
$50K |
| E2394 |
Drive wheel excludes tire |
790 |
733 |
$43K |
| E0637 |
Combination sit to stand sys |
16 |
14 |
$34K |
| E2359 |
Gr34 sealed leadacid battery |
179 |
167 |
$33K |
| E0953 |
W/c lateral thigh/knee sup |
328 |
272 |
$27K |
| E2366 |
Battery charger, single mode |
264 |
255 |
$26K |
| E0951 |
Loop heel |
1,068 |
911 |
$21K |
| E2615 |
Pos back post/lat wdth <22in |
78 |
74 |
$21K |
| E2609 |
Custom fabricate w/c cushion |
14 |
12 |
$19K |
| E1002 |
Pwr seat tilt |
12 |
12 |
$18K |
| K0019 |
Arm pad repl, each |
1,348 |
1,187 |
$16K |
| E2611 |
Gen use back cush wdth <22in |
85 |
80 |
$14K |
| K0001 |
Standard wheelchair |
193 |
190 |
$12K |
| E2613 |
Position back cush wd <22in |
42 |
39 |
$11K |
| E2370 |
Pwr wc dr wh motor/gear comb |
17 |
14 |
$10K |
| E0950 |
Tray |
120 |
109 |
$8K |
| E2211 |
Pneumatic propulsion tire |
141 |
130 |
$7K |
| A4927 |
Non-sterile gloves |
658 |
576 |
$7K |
| E2365 |
U1 sealed leadacid battery |
85 |
83 |
$6K |
| E2601 |
Gen w/c cushion wdth < 22 in |
159 |
153 |
$6K |
| E2209 |
Arm trough each |
53 |
49 |
$4K |
| E0961 |
Wheelchair brake extension |
130 |
110 |
$3K |
| E0990 |
Wheelchair elevating leg res |
27 |
27 |
$3K |
| E2605 |
Position wc cush wdth <22 in |
14 |
12 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
50 |
36 |
$2K |
| E2210 |
Wheelchair bearings |
79 |
77 |
$1K |
| E2213 |
Pneumatic prop tire insert |
13 |
12 |
$677.79 |
| K0018 |
Detach adjust armrst upper |
51 |
40 |
$663.69 |
| K0017 |
Detach adjust armrest base |
13 |
13 |
$501.39 |
| T4541 |
Large disposable underpad |
13 |
12 |
$318.16 |
| K0038 |
Leg strap each |
12 |
12 |
$202.62 |
| A4402 |
Lubricant per ounce |
13 |
12 |
$54.13 |