| Code | Description | Claims | Beneficiaries | Total Paid |
| E1399 |
Durable medical equipment mi |
1,110 |
558 |
$2.45M |
| K0108 |
W/c component-accessory nos |
1,465 |
876 |
$1.19M |
| E2617 |
Custom fab w/c back cushion |
153 |
83 |
$366K |
| E1028 |
W/c manual swingaway |
1,724 |
1,213 |
$227K |
| E1161 |
Manual adult wc w tiltinspac |
525 |
391 |
$136K |
| E0955 |
Cushioned headrest |
1,145 |
916 |
$72K |
| E2609 |
Custom fabricate w/c cushion |
51 |
27 |
$68K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,305 |
1,088 |
$61K |
| E0973 |
W/ch access det adj armrest |
276 |
221 |
$31K |
| K0040 |
Adjustable angle footplate |
308 |
232 |
$21K |
| E0960 |
W/c shoulder harness/straps |
363 |
286 |
$20K |
| T2029 |
Special med equip, noswaiver |
14 |
12 |
$18K |
| E0978 |
W/c acc,saf belt pelv strap |
458 |
404 |
$10K |
| E0971 |
Wheelchair anti-tipping devi |
190 |
159 |
$9K |
| E0956 |
W/c lateral trunk/hip suppor |
43 |
32 |
$7K |
| E0950 |
Tray |
75 |
63 |
$5K |
| E2219 |
Foam caster tire any size ea |
69 |
53 |
$3K |
| E2213 |
Pneumatic prop tire insert |
73 |
53 |
$2K |
| E0951 |
Loop heel |
82 |
57 |
$1K |