| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
11,385 |
1,663 |
$3.37M |
| A4353 |
Intermittent urinary cath |
3,706 |
3,233 |
$1.76M |
| K0108 |
W/c component-accessory nos |
22,472 |
5,359 |
$1.49M |
| E1161 |
Manual adult wc w tiltinspac |
2,781 |
2,046 |
$876K |
| E1028 |
W/c manual swingaway |
14,593 |
6,591 |
$720K |
| A4351 |
Straight tip urine catheter |
7,557 |
6,555 |
$663K |
| K0739 |
Repair/svc dme non-oxygen eq |
12,851 |
7,873 |
$420K |
| K0823 |
Pwc gp 2 std cap chair |
3,286 |
2,482 |
$344K |
| E0955 |
Cushioned headrest |
5,128 |
3,368 |
$275K |
| E0973 |
W/ch access det adj armrest |
4,560 |
2,218 |
$212K |
| E2617 |
Custom fab w/c back cushion |
149 |
80 |
$185K |
| A4352 |
Coude tip urinary catheter |
834 |
677 |
$177K |
| K0040 |
Adjustable angle footplate |
2,783 |
1,408 |
$155K |
| E2609 |
Custom fabricate w/c cushion |
137 |
63 |
$148K |
| E0960 |
W/c shoulder harness/straps |
2,421 |
1,341 |
$135K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,064 |
656 |
$134K |
| K0005 |
Ultralightweight wheelchair |
136 |
91 |
$110K |
| E0971 |
Wheelchair anti-tipping devi |
2,902 |
1,609 |
$104K |
| E0956 |
W/c lateral trunk/hip suppor |
1,635 |
578 |
$94K |
| E0978 |
W/c acc,saf belt pelv strap |
3,452 |
1,985 |
$53K |
| K0825 |
Pwc gp 2 hd cap chair |
266 |
201 |
$43K |
| E2361 |
22nf sealed leadacid battery |
560 |
330 |
$40K |
| E0950 |
Tray |
687 |
398 |
$39K |
| E2624 |
Adj skin pro/pos cus<22in |
280 |
156 |
$37K |
| E0630 |
Patient lift hydraulic |
509 |
458 |
$34K |
| T5001 |
Position seat spec orth need |
23 |
13 |
$30K |
| E2620 |
Wc planar back cush wd <22in |
176 |
87 |
$29K |
| E2392 |
Solid caster tire, integrate |
663 |
340 |
$25K |
| A4349 |
Disposable male external cat |
825 |
682 |
$22K |
| A4344 |
Cath indw foley 2 way silicn |
840 |
733 |
$20K |
| A4332 |
Lube sterile packet |
2,713 |
2,372 |
$18K |
| E2311 |
Electro connect btw 2 sys |
15 |
12 |
$18K |
| E2213 |
Pneumatic prop tire insert |
850 |
446 |
$17K |
| E2231 |
Solid seat support base |
175 |
111 |
$16K |
| E2359 |
Gr34 sealed leadacid battery |
144 |
98 |
$16K |
| E2386 |
Foam filled drive wheel tire |
204 |
104 |
$14K |
| A4217 |
Sterile water/saline, 500 ml |
771 |
676 |
$14K |
| E0951 |
Loop heel |
882 |
495 |
$12K |
| A4402 |
Lubricant per ounce |
3,404 |
3,067 |
$12K |
| E2211 |
Pneumatic propulsion tire |
563 |
283 |
$11K |
| E2394 |
Drive wheel excludes tire |
307 |
151 |
$11K |
| A4357 |
Bedside drainage bag |
1,990 |
1,639 |
$10K |
| E0240 |
Bath/shower chair |
15 |
13 |
$10K |
| K0019 |
Arm pad repl, each |
1,261 |
663 |
$9K |
| E2374 |
Hand/chin ctrl std joystick |
73 |
47 |
$8K |
| A9900 |
Supply/accessory/service |
58 |
12 |
$7K |
| K0038 |
Leg strap each |
289 |
162 |
$6K |
| A4358 |
Urinary leg or abdomen bag |
1,325 |
1,092 |
$5K |
| E2615 |
Pos back post/lat wdth <22in |
16 |
12 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
46 |
25 |
$3K |
| A4927 |
Non-sterile gloves |
803 |
625 |
$3K |
| E2206 |
Man wc whl lock comp repl ea |
92 |
52 |
$3K |
| E2366 |
Battery charger, single mode |
65 |
38 |
$3K |
| E2313 |
Pwc harness, expand control |
15 |
12 |
$2K |
| E2365 |
U1 sealed leadacid battery |
88 |
56 |
$2K |
| A4398 |
Ostomy irrigation bag |
345 |
281 |
$2K |
| A4322 |
Irrigation syringe |
348 |
283 |
$1K |
| E0961 |
Wheelchair brake extension |
21 |
14 |
$466.77 |
| E2619 |
Replace cover w/c seat cush |
34 |
26 |
$225.92 |