| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,763 |
1,740 |
$5.41M |
| K0005 |
Ultralightweight wheelchair |
2,021 |
2,001 |
$4.83M |
| E2203 |
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
1,590 |
1,574 |
$849K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,739 |
2,498 |
$760K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,957 |
3,911 |
$738K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
1,601 |
1,596 |
$608K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,916 |
5,837 |
$598K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
1,958 |
1,937 |
$542K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,391 |
5,288 |
$490K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,103 |
1,091 |
$458K |
| A4927 |
Gloves, non-sterile, per 100 |
17,406 |
16,622 |
$457K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
2,475 |
2,452 |
$424K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,118 |
2,097 |
$410K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,912 |
3,863 |
$376K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,505 |
1,127 |
$367K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,412 |
3,365 |
$351K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
40 |
40 |
$346K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,822 |
5,603 |
$317K |
| K0040 |
Adjustable angle footplate, each |
1,776 |
1,750 |
$251K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
473 |
467 |
$247K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
86 |
86 |
$202K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,209 |
5,073 |
$192K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
621 |
609 |
$185K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
993 |
986 |
$144K |
| E2608 |
Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth |
409 |
405 |
$138K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
668 |
662 |
$127K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
2,793 |
2,757 |
$102K |
| E2614 |
Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware |
175 |
174 |
$91K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,194 |
3,147 |
$85K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
833 |
813 |
$77K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
149 |
149 |
$71K |
| E2615 |
Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
127 |
124 |
$55K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
150 |
150 |
$55K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
641 |
633 |
$45K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
268 |
250 |
$43K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
41 |
41 |
$41K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
317 |
313 |
$39K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
630 |
627 |
$36K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
167 |
165 |
$30K |
| A4335 |
Incontinence supply; miscellaneous |
855 |
853 |
$23K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
69 |
68 |
$22K |
| S9999 |
Sales tax |
63 |
60 |
$20K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
113 |
113 |
$17K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
116 |
108 |
$9K |
| E2209 |
Accessory, arm trough, with or without hand support, each |
70 |
69 |
$8K |
| E2359 |
Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
14 |
14 |
$6K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
85 |
82 |
$5K |
| K0038 |
Leg strap, each |
199 |
198 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
39 |
39 |
$3K |
| E0954 |
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
15 |
15 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
146 |
125 |
$1K |
| A4256 |
Normal, low and high calibrator solution / chips |
119 |
104 |
$102.38 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
632 |
419 |
$0.00 |