| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,899 |
1,934 |
$5.17M |
| E1399 |
Durable medical equipment mi |
4,111 |
761 |
$2.39M |
| E1161 |
Manual adult wc w tiltinspac |
1,186 |
897 |
$1.81M |
| K0005 |
Ultralightweight wheelchair |
1,284 |
1,015 |
$1.74M |
| E1007 |
Pwr seat combo w/shear |
150 |
66 |
$359K |
| E2615 |
Pos back post/lat wdth <22in |
1,294 |
995 |
$344K |
| E0973 |
W/ch access det adj armrest |
3,642 |
2,339 |
$256K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,577 |
1,169 |
$247K |
| E2203 |
Frame depth less than 22 in |
758 |
467 |
$207K |
| E1028 |
W/c manual swingaway |
2,345 |
741 |
$161K |
| E0971 |
Wheelchair anti-tipping devi |
3,268 |
2,154 |
$134K |
| E0990 |
Wheelchair elevating leg res |
1,183 |
817 |
$112K |
| E2311 |
Electro connect btw 2 sys |
122 |
69 |
$104K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
467 |
298 |
$97K |
| E0955 |
Cushioned headrest |
1,155 |
692 |
$90K |
| E2620 |
Wc planar back cush wd <22in |
265 |
215 |
$65K |
| E8000 |
Posterior gait trainer |
292 |
139 |
$64K |
| E2300 |
Pwr seat elevation sys |
60 |
29 |
$62K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
14 |
12 |
$57K |
| E0961 |
Wheelchair brake extension |
1,815 |
1,313 |
$54K |
| E2613 |
Position back cush wd <22in |
190 |
134 |
$39K |
| E2231 |
Solid seat support base |
433 |
275 |
$39K |
| E0956 |
W/c lateral trunk/hip suppor |
512 |
242 |
$36K |
| E1012 |
Ctr mount pwr elev leg rest |
71 |
54 |
$33K |
| E0951 |
Loop heel |
1,841 |
1,321 |
$32K |
| E2377 |
Expandable controller, initl |
165 |
79 |
$26K |
| E2313 |
Pwc harness, expand control |
160 |
77 |
$20K |
| E2622 |
Adj skin pro w/c cus wd<22in |
100 |
72 |
$18K |
| E2298 |
Pwr seat elev sys for crt |
20 |
13 |
$16K |
| E0261 |
Hosp bed semi-electr w/o mat |
202 |
193 |
$15K |
| K0040 |
Adjustable angle footplate |
221 |
131 |
$12K |
| E0953 |
W/c lateral thigh/knee sup |
213 |
53 |
$5K |
| L2840 |
Tibial length sock fx or equ |
130 |
55 |
$4K |
| K0823 |
Pwc gp 2 std cap chair |
76 |
75 |
$4K |
| E2359 |
Gr34 sealed leadacid battery |
15 |
13 |
$3K |
| E0950 |
Tray |
54 |
37 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
14 |
12 |
$2K |
| K0004 |
High strength ltwt whlchr |
95 |
94 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
131 |
99 |
$2K |
| E2603 |
Skin protect wc cus wd <22in |
18 |
15 |
$1K |
| E2213 |
Pneumatic prop tire insert |
27 |
14 |
$861.00 |
| E2211 |
Pneumatic propulsion tire |
21 |
12 |
$773.96 |
| L3206 |
Hightop w/ supp/pronator chi |
21 |
15 |
$700.00 |