| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
1,763 |
1,740 |
$5.41M |
| K0005 |
Ultralightweight wheelchair |
2,021 |
2,001 |
$4.83M |
| E2203 |
Frame depth less than 22 in |
1,590 |
1,574 |
$849K |
| E1028 |
W/c manual swingaway |
2,739 |
2,498 |
$760K |
| E0973 |
W/ch access det adj armrest |
3,957 |
3,911 |
$738K |
| E2613 |
Position back cush wd <22in |
1,601 |
1,596 |
$608K |
| T4527 |
Adult size pull-on lg |
5,916 |
5,837 |
$598K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,958 |
1,937 |
$542K |
| T4526 |
Adult size pull-on med |
5,391 |
5,288 |
$490K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,103 |
1,091 |
$458K |
| A4927 |
Non-sterile gloves |
17,406 |
16,622 |
$457K |
| E2231 |
Solid seat support base |
2,475 |
2,452 |
$424K |
| E0955 |
Cushioned headrest |
2,118 |
2,097 |
$410K |
| E0971 |
Wheelchair anti-tipping devi |
3,912 |
3,863 |
$376K |
| K0108 |
W/c component-accessory nos |
1,505 |
1,127 |
$367K |
| T4528 |
Adult size pull-on xl |
3,412 |
3,365 |
$351K |
| E1007 |
Pwr seat combo w/shear |
40 |
40 |
$346K |
| T4535 |
Disposable liner/shield/pad |
5,822 |
5,603 |
$317K |
| K0040 |
Adjustable angle footplate |
1,776 |
1,750 |
$251K |
| E2620 |
Wc planar back cush wd <22in |
473 |
467 |
$247K |
| E2311 |
Electro connect btw 2 sys |
86 |
86 |
$202K |
| T4537 |
Reusable underpad bed size |
5,209 |
5,073 |
$192K |
| E2611 |
Gen use back cush wdth <22in |
621 |
609 |
$185K |
| E2603 |
Skin protect wc cus wd <22in |
993 |
986 |
$144K |
| E2608 |
Skin pro/pos wc cus wd>=22in |
409 |
405 |
$138K |
| E0990 |
Wheelchair elevating leg res |
668 |
662 |
$127K |
| E0951 |
Loop heel |
2,793 |
2,757 |
$102K |
| E2614 |
Position back cush wd>=22in |
175 |
174 |
$91K |
| T4541 |
Large disposable underpad |
3,194 |
3,147 |
$85K |
| T4523 |
Adult size brief/diaper lg |
833 |
813 |
$77K |
| E2377 |
Expandable controller, initl |
149 |
149 |
$71K |
| E2615 |
Pos back post/lat wdth <22in |
127 |
124 |
$55K |
| E2313 |
Pwc harness, expand control |
150 |
150 |
$55K |
| K0739 |
Repair/svc dme non-oxygen eq |
641 |
633 |
$45K |
| E0956 |
W/c lateral trunk/hip suppor |
268 |
250 |
$43K |
| E1012 |
Ctr mount pwr elev leg rest |
41 |
41 |
$41K |
| T4524 |
Adult size brief/diaper xl |
317 |
313 |
$39K |
| E0961 |
Wheelchair brake extension |
630 |
627 |
$36K |
| T4544 |
Adlt disp und/pull on abv xl |
167 |
165 |
$30K |
| A4335 |
Incontinence supply |
855 |
853 |
$23K |
| E2624 |
Adj skin pro/pos cus<22in |
69 |
68 |
$22K |
| S9999 |
Sales tax |
63 |
60 |
$20K |
| E0953 |
W/c lateral thigh/knee sup |
113 |
113 |
$17K |
| T4525 |
Adult size pull-on sm |
116 |
108 |
$9K |
| E2209 |
Arm trough each |
70 |
69 |
$8K |
| E2359 |
Gr34 sealed leadacid battery |
14 |
14 |
$6K |
| E2601 |
Gen w/c cushion wdth < 22 in |
85 |
82 |
$5K |
| K0038 |
Leg strap each |
199 |
198 |
$5K |
| T4522 |
Adult size brief/diaper med |
39 |
39 |
$3K |
| E0954 |
Foot box, any type each foot |
15 |
15 |
$2K |
| A4253 |
Blood glucose/reagent strips |
146 |
125 |
$1K |
| A4256 |
Calibrator solution/chips |
119 |
104 |
$102.38 |
| A4520 |
Incontinence garment anytype |
632 |
419 |
$0.00 |