| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,033 |
1,192 |
$4.01M |
| K0108 |
W/c component-accessory nos |
5,196 |
3,852 |
$985K |
| E1028 |
W/c manual swingaway |
5,682 |
4,100 |
$327K |
| E1161 |
Manual adult wc w tiltinspac |
1,992 |
1,969 |
$277K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,463 |
5,040 |
$111K |
| E1236 |
Folding ped wc adjustable |
267 |
265 |
$106K |
| E0955 |
Cushioned headrest |
2,765 |
2,684 |
$91K |
| E0973 |
W/ch access det adj armrest |
1,209 |
1,072 |
$76K |
| K0005 |
Ultralightweight wheelchair |
58 |
55 |
$54K |
| E2607 |
Skin pro/pos wc cus wd <22in |
384 |
366 |
$52K |
| E1007 |
Pwr seat combo w/shear |
18 |
16 |
$50K |
| K0040 |
Adjustable angle footplate |
737 |
655 |
$46K |
| E0971 |
Wheelchair anti-tipping devi |
826 |
765 |
$43K |
| E0960 |
W/c shoulder harness/straps |
773 |
726 |
$38K |
| E2620 |
Wc planar back cush wd <22in |
169 |
156 |
$38K |
| E0956 |
W/c lateral trunk/hip suppor |
413 |
324 |
$35K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
17 |
15 |
$33K |
| E0978 |
W/c acc,saf belt pelv strap |
1,186 |
1,144 |
$29K |
| E2361 |
22nf sealed leadacid battery |
306 |
283 |
$26K |
| K0823 |
Pwc gp 2 std cap chair |
101 |
101 |
$17K |
| E2311 |
Electro connect btw 2 sys |
19 |
17 |
$17K |
| E2617 |
Custom fab w/c back cushion |
13 |
12 |
$16K |
| E0950 |
Tray |
209 |
200 |
$14K |
| E2213 |
Pneumatic prop tire insert |
436 |
403 |
$13K |
| E0951 |
Loop heel |
575 |
520 |
$11K |
| E2211 |
Pneumatic propulsion tire |
331 |
306 |
$11K |
| E1012 |
Ctr mount pwr elev leg rest |
21 |
18 |
$10K |
| E2392 |
Solid caster tire, integrate |
174 |
156 |
$8K |
| E2366 |
Battery charger, single mode |
89 |
89 |
$6K |
| K0821 |
Pwc gp 2 std port cap chair |
25 |
25 |
$5K |
| E2231 |
Solid seat support base |
61 |
60 |
$5K |
| K0019 |
Arm pad repl, each |
432 |
386 |
$5K |
| E2386 |
Foam filled drive wheel tire |
35 |
29 |
$4K |
| E2377 |
Expandable controller, initl |
16 |
16 |
$3K |
| E0952 |
Toe loop/holder, each |
130 |
124 |
$3K |
| E2313 |
Pwc harness, expand control |
15 |
15 |
$2K |
| E2622 |
Adj skin pro w/c cus wd<22in |
12 |
12 |
$1K |
| E2359 |
Gr34 sealed leadacid battery |
13 |
12 |
$1K |
| E0966 |
Wheelchair head rest extensi |
27 |
26 |
$1K |
| E0961 |
Wheelchair brake extension |
51 |
44 |
$1K |
| E2394 |
Drive wheel excludes tire |
18 |
14 |
$1K |