| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,379 |
1,542 |
$2.70M |
| K0108 |
W/c component-accessory nos |
3,294 |
1,387 |
$950K |
| E1028 |
W/c manual swingaway |
2,814 |
2,175 |
$835K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,820 |
3,332 |
$472K |
| E0955 |
Cushioned headrest |
1,006 |
900 |
$116K |
| E0956 |
W/c lateral trunk/hip suppor |
726 |
622 |
$98K |
| K0040 |
Adjustable angle footplate |
1,028 |
929 |
$92K |
| E2617 |
Custom fab w/c back cushion |
139 |
110 |
$84K |
| E0960 |
W/c shoulder harness/straps |
1,023 |
915 |
$68K |
| K0005 |
Ultralightweight wheelchair |
43 |
39 |
$63K |
| A9900 |
Supply/accessory/service |
137 |
124 |
$56K |
| E0973 |
W/ch access det adj armrest |
299 |
264 |
$36K |
| E8000 |
Posterior gait trainer |
17 |
13 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
477 |
427 |
$25K |
| E0978 |
W/c acc,saf belt pelv strap |
1,012 |
942 |
$25K |
| E2607 |
Skin pro/pos wc cus wd <22in |
114 |
99 |
$18K |
| K0071 |
Fr cstr comp pne tire rep ea |
86 |
81 |
$16K |
| E2609 |
Custom fabricate w/c cushion |
24 |
24 |
$15K |
| K0070 |
Rr whl compl pne tire rep ea |
46 |
42 |
$14K |
| E1296 |
Wheelchair special seat heig |
45 |
44 |
$11K |
| E1298 |
Wheelchair spec seat depth/w |
53 |
51 |
$9K |
| K0039 |
Leg strap h style each |
99 |
91 |
$7K |
| E2219 |
Foam caster tire any size ea |
91 |
86 |
$6K |
| E2613 |
Position back cush wd <22in |
14 |
14 |
$5K |
| E2231 |
Solid seat support base |
29 |
27 |
$4K |
| E2213 |
Pneumatic prop tire insert |
79 |
71 |
$4K |
| E0961 |
Wheelchair brake extension |
99 |
86 |
$3K |
| E2211 |
Pneumatic propulsion tire |
56 |
46 |
$3K |
| E0950 |
Tray |
26 |
26 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
27 |
25 |
$2K |
| K0052 |
Swingaway detach ftrest repl |
13 |
13 |
$1K |
| E2619 |
Replace cover w/c seat cush |
29 |
26 |
$1K |
| A9270 |
Non-covered item or service |
638 |
491 |
$828.48 |
| E0966 |
Wheelchair head rest extensi |
14 |
14 |
$803.07 |
| E0951 |
Loop heel |
30 |
27 |
$552.01 |