| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
11,797 |
2,735 |
$5.33M |
| K0108 |
W/c component-accessory nos |
13,823 |
3,717 |
$2.64M |
| E2617 |
Custom fab w/c back cushion |
1,059 |
1,000 |
$1.95M |
| E2609 |
Custom fabricate w/c cushion |
959 |
913 |
$1.80M |
| E0240 |
Bath/shower chair |
861 |
825 |
$1.20M |
| E1161 |
Manual adult wc w tiltinspac |
1,808 |
1,787 |
$680K |
| E1028 |
W/c manual swingaway |
5,447 |
3,601 |
$644K |
| K0005 |
Ultralightweight wheelchair |
276 |
275 |
$412K |
| E0329 |
Ped hospital bed semi/elect |
53 |
51 |
$361K |
| E8001 |
Upright gait trainer |
157 |
149 |
$351K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,166 |
3,608 |
$286K |
| E0956 |
W/c lateral trunk/hip suppor |
1,338 |
1,140 |
$240K |
| E0955 |
Cushioned headrest |
3,285 |
3,192 |
$230K |
| E2607 |
Skin pro/pos wc cus wd <22in |
823 |
772 |
$217K |
| E2613 |
Position back cush wd <22in |
561 |
533 |
$197K |
| E0973 |
W/ch access det adj armrest |
1,755 |
1,577 |
$170K |
| K0040 |
Adjustable angle footplate |
1,876 |
1,715 |
$150K |
| E0960 |
W/c shoulder harness/straps |
1,969 |
1,899 |
$141K |
| E1236 |
Folding ped wc adjustable |
89 |
86 |
$138K |
| E0950 |
Tray |
1,263 |
1,210 |
$133K |
| E0971 |
Wheelchair anti-tipping devi |
1,580 |
1,451 |
$84K |
| E0978 |
W/c acc,saf belt pelv strap |
2,383 |
2,303 |
$62K |
| E1234 |
Fld ped wc tltnspc w/o seat |
39 |
38 |
$60K |
| E0637 |
Combination sit to stand sys |
13 |
13 |
$43K |
| E2213 |
Pneumatic prop tire insert |
907 |
840 |
$39K |
| 97542 |
|
1,343 |
1,217 |
$28K |
| E1232 |
Folding ped wc tilt-in-space |
14 |
14 |
$26K |
| E0961 |
Wheelchair brake extension |
439 |
408 |
$14K |
| E2211 |
Pneumatic propulsion tire |
316 |
293 |
$14K |
| K0823 |
Pwc gp 2 std cap chair |
28 |
25 |
$14K |
| E0315 |
Bed accessory brd/tbl/supprt |
57 |
52 |
$12K |
| E2219 |
Foam caster tire any size ea |
175 |
159 |
$8K |
| E0951 |
Loop heel |
401 |
355 |
$7K |
| K0077 |
Fr cstr asmb sol tire rep ea |
46 |
41 |
$4K |
| K0019 |
Arm pad repl, each |
140 |
127 |
$2K |
| K0038 |
Leg strap each |
96 |
96 |
$2K |
| E0957 |
W/c medial thigh support |
13 |
12 |
$1K |
| K0105 |
Iv hanger |
13 |
12 |
$988.23 |
| E2619 |
Replace cover w/c seat cush |
14 |
13 |
$722.97 |