| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,405 |
807 |
$1.48M |
| K0108 |
W/c component-accessory nos |
8,762 |
4,259 |
$813K |
| E1028 |
W/c manual swingaway |
10,392 |
6,282 |
$582K |
| E1161 |
Manual adult wc w tiltinspac |
3,029 |
2,184 |
$422K |
| K0823 |
Pwc gp 2 std cap chair |
3,553 |
2,959 |
$368K |
| K0739 |
Repair/svc dme non-oxygen eq |
9,520 |
7,409 |
$249K |
| E0973 |
W/ch access det adj armrest |
3,232 |
2,409 |
$204K |
| K0004 |
High strength ltwt whlchr |
2,277 |
1,939 |
$184K |
| E0955 |
Cushioned headrest |
4,605 |
3,460 |
$167K |
| E2311 |
Electro connect btw 2 sys |
191 |
166 |
$166K |
| E2361 |
22nf sealed leadacid battery |
1,715 |
1,391 |
$153K |
| E2607 |
Skin pro/pos wc cus wd <22in |
969 |
798 |
$126K |
| K0825 |
Pwc gp 2 hd cap chair |
694 |
630 |
$118K |
| E2392 |
Solid caster tire, integrate |
1,674 |
1,211 |
$85K |
| E1007 |
Pwr seat combo w/shear |
33 |
25 |
$78K |
| E2370 |
Pwr wc dr wh motor/gear comb |
238 |
146 |
$75K |
| K0005 |
Ultralightweight wheelchair |
65 |
56 |
$74K |
| E1002 |
Pwr seat tilt |
63 |
50 |
$68K |
| E2374 |
Hand/chin ctrl std joystick |
446 |
345 |
$67K |
| E2386 |
Foam filled drive wheel tire |
748 |
580 |
$66K |
| E1012 |
Ctr mount pwr elev leg rest |
131 |
115 |
$59K |
| K0040 |
Adjustable angle footplate |
1,207 |
835 |
$57K |
| E0971 |
Wheelchair anti-tipping devi |
1,913 |
1,572 |
$54K |
| E2620 |
Wc planar back cush wd <22in |
209 |
167 |
$40K |
| E2394 |
Drive wheel excludes tire |
868 |
680 |
$40K |
| E0978 |
W/c acc,saf belt pelv strap |
2,507 |
2,099 |
$37K |
| E0956 |
W/c lateral trunk/hip suppor |
391 |
288 |
$34K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
13 |
13 |
$31K |
| E2366 |
Battery charger, single mode |
360 |
292 |
$31K |
| E0960 |
W/c shoulder harness/straps |
494 |
440 |
$27K |
| E2617 |
Custom fab w/c back cushion |
31 |
25 |
$16K |
| T4541 |
Large disposable underpad |
752 |
615 |
$15K |
| E2363 |
Gr24 sealed leadacid battery |
130 |
104 |
$14K |
| E2365 |
U1 sealed leadacid battery |
201 |
157 |
$11K |
| K0019 |
Arm pad repl, each |
1,426 |
932 |
$10K |
| E2377 |
Expandable controller, initl |
62 |
54 |
$9K |
| E2211 |
Pneumatic propulsion tire |
268 |
225 |
$9K |
| E2313 |
Pwc harness, expand control |
78 |
69 |
$9K |
| A4927 |
Non-sterile gloves |
780 |
555 |
$8K |
| E2213 |
Pneumatic prop tire insert |
331 |
275 |
$8K |
| E0951 |
Loop heel |
448 |
330 |
$6K |
| E2231 |
Solid seat support base |
73 |
64 |
$6K |
| E2622 |
Adj skin pro w/c cus wd<22in |
65 |
50 |
$5K |
| E0961 |
Wheelchair brake extension |
430 |
358 |
$5K |
| E2615 |
Pos back post/lat wdth <22in |
14 |
12 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
105 |
81 |
$2K |
| E0950 |
Tray |
27 |
24 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
59 |
40 |
$1K |
| K0195 |
Elevating whlchair leg rests |
72 |
51 |
$155.14 |