| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,539 |
1,004 |
$2.77M |
| K0108 |
W/c component-accessory nos |
1,955 |
1,158 |
$401K |
| E1028 |
W/c manual swingaway |
1,946 |
959 |
$147K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,721 |
2,082 |
$126K |
| E0955 |
Cushioned headrest |
552 |
432 |
$38K |
| K0823 |
Pwc gp 2 std cap chair |
88 |
76 |
$23K |
| E0973 |
W/ch access det adj armrest |
298 |
186 |
$20K |
| E0956 |
W/c lateral trunk/hip suppor |
214 |
100 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
113 |
76 |
$11K |
| E0960 |
W/c shoulder harness/straps |
155 |
118 |
$7K |
| K0040 |
Adjustable angle footplate |
118 |
63 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
341 |
258 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
111 |
73 |
$4K |
| E0950 |
Tray |
41 |
25 |
$2K |
| E2366 |
Battery charger, single mode |
16 |
13 |
$1K |
| E2392 |
Solid caster tire, integrate |
37 |
26 |
$593.43 |
| E0951 |
Loop heel |
26 |
13 |
$365.02 |