| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
6,478 |
2,669 |
$4.83M |
| K0108 |
W/c component-accessory nos |
10,682 |
4,757 |
$2.11M |
| E1028 |
W/c manual swingaway |
6,800 |
4,070 |
$932K |
| E1161 |
Manual adult wc w tiltinspac |
1,542 |
1,076 |
$858K |
| E0956 |
W/c lateral trunk/hip suppor |
2,485 |
1,865 |
$428K |
| E0973 |
W/ch access det adj armrest |
2,360 |
1,938 |
$326K |
| K0005 |
Ultralightweight wheelchair |
182 |
161 |
$233K |
| K0040 |
Adjustable angle footplate |
2,116 |
1,667 |
$193K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,708 |
4,850 |
$165K |
| E0960 |
W/c shoulder harness/straps |
2,097 |
1,779 |
$142K |
| E0971 |
Wheelchair anti-tipping devi |
2,285 |
1,863 |
$123K |
| E2617 |
Custom fab w/c back cushion |
179 |
158 |
$121K |
| E1007 |
Pwr seat combo w/shear |
17 |
14 |
$107K |
| E0950 |
Tray |
1,330 |
1,127 |
$106K |
| E2211 |
Pneumatic propulsion tire |
1,783 |
1,451 |
$94K |
| E2311 |
Electro connect btw 2 sys |
68 |
56 |
$84K |
| E2607 |
Skin pro/pos wc cus wd <22in |
433 |
375 |
$84K |
| E0978 |
W/c acc,saf belt pelv strap |
2,813 |
2,369 |
$78K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
15 |
12 |
$63K |
| K0823 |
Pwc gp 2 std cap chair |
529 |
451 |
$53K |
| E0700 |
Safety equipment |
77 |
54 |
$46K |
| E2613 |
Position back cush wd <22in |
134 |
117 |
$34K |
| E1012 |
Ctr mount pwr elev leg rest |
17 |
13 |
$30K |
| E2609 |
Custom fabricate w/c cushion |
45 |
39 |
$26K |
| E2231 |
Solid seat support base |
211 |
187 |
$25K |
| E2377 |
Expandable controller, initl |
61 |
51 |
$18K |
| E2313 |
Pwc harness, expand control |
70 |
51 |
$16K |
| E2620 |
Wc planar back cush wd <22in |
31 |
28 |
$10K |
| E2622 |
Adj skin pro w/c cus wd<22in |
49 |
39 |
$8K |
| E0961 |
Wheelchair brake extension |
189 |
156 |
$7K |
| E0955 |
Cushioned headrest |
701 |
580 |
$6K |
| W4132 |
|
466 |
428 |
$6K |
| E2363 |
Gr24 sealed leadacid battery |
32 |
24 |
$5K |
| E2219 |
Foam caster tire any size ea |
64 |
64 |
$5K |
| E2361 |
22nf sealed leadacid battery |
44 |
38 |
$5K |
| E0951 |
Loop heel |
226 |
182 |
$4K |
| K0019 |
Arm pad repl, each |
29 |
25 |
$340.89 |
| K0043 |
Ftrst lowr exten tube rep ea |
12 |
12 |
$234.44 |