| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,412 |
1,134 |
$2.17M |
| K0108 |
W/c component-accessory nos |
4,804 |
3,552 |
$1.24M |
| E1028 |
W/c manual swingaway |
3,306 |
2,492 |
$505K |
| K0739 |
Repair/svc dme non-oxygen eq |
6,236 |
5,385 |
$479K |
| K0669 |
Seat/back cus no dmepdac ver |
28 |
25 |
$224K |
| A9900 |
Supply/accessory/service |
1,910 |
1,538 |
$194K |
| E0973 |
W/ch access det adj armrest |
1,165 |
1,041 |
$175K |
| E0955 |
Cushioned headrest |
1,909 |
1,579 |
$166K |
| K0040 |
Adjustable angle footplate |
406 |
381 |
$43K |
| E0960 |
W/c shoulder harness/straps |
561 |
515 |
$41K |
| E0978 |
W/c acc,saf belt pelv strap |
1,345 |
1,179 |
$41K |
| E1161 |
Manual adult wc w tiltinspac |
53 |
50 |
$40K |
| K0823 |
Pwc gp 2 std cap chair |
336 |
308 |
$34K |
| E2607 |
Skin pro/pos wc cus wd <22in |
98 |
92 |
$23K |
| E0971 |
Wheelchair anti-tipping devi |
418 |
384 |
$20K |
| E2392 |
Solid caster tire, integrate |
139 |
131 |
$10K |
| E2213 |
Pneumatic prop tire insert |
247 |
230 |
$9K |
| E0950 |
Tray |
57 |
50 |
$8K |
| E2211 |
Pneumatic propulsion tire |
180 |
172 |
$8K |
| E2386 |
Foam filled drive wheel tire |
51 |
49 |
$7K |
| E2394 |
Drive wheel excludes tire |
53 |
52 |
$4K |
| E2622 |
Adj skin pro w/c cus wd<22in |
22 |
13 |
$3K |
| E0951 |
Loop heel |
126 |
116 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
12 |
12 |
$2K |
| K0019 |
Arm pad repl, each |
146 |
113 |
$1K |
| E0956 |
W/c lateral trunk/hip suppor |
13 |
12 |
$897.77 |
| E2206 |
Man wc whl lock comp repl ea |
22 |
15 |
$775.44 |
| E0961 |
Wheelchair brake extension |
13 |
13 |
$440.94 |