| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
544 |
538 |
$332K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
741 |
679 |
$282K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,032 |
822 |
$145K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
818 |
798 |
$50K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
371 |
316 |
$28K |
| K0040 |
Adjustable angle footplate, each |
307 |
288 |
$26K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
518 |
492 |
$23K |
| T4541 |
Incontinence product, disposable underpad, large, each |
744 |
731 |
$17K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
77 |
77 |
$14K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
44 |
44 |
$12K |
| K0003 |
Lightweight wheelchair |
397 |
391 |
$12K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,628 |
1,433 |
$12K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
45 |
44 |
$8K |
| K0001 |
Standard wheelchair |
299 |
296 |
$6K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
46 |
41 |
$6K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
43 |
43 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
134 |
129 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
341 |
198 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
15 |
14 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
696 |
683 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
58 |
52 |
$807.70 |