| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
6,435 |
5,148 |
$8.86M |
| K0108 |
W/c component-accessory nos |
21,860 |
14,535 |
$5.68M |
| K0669 |
Seat/back cus no dmepdac ver |
746 |
638 |
$4.75M |
| E1007 |
Pwr seat combo w/shear |
892 |
748 |
$4.31M |
| K0005 |
Ultralightweight wheelchair |
2,364 |
2,035 |
$3.34M |
| E1028 |
W/c manual swingaway |
12,687 |
9,430 |
$2.35M |
| A4353 |
Intermittent urinary cath |
3,173 |
2,514 |
$2.35M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
672 |
537 |
$2.24M |
| K0739 |
Repair/svc dme non-oxygen eq |
25,851 |
20,902 |
$2.09M |
| E0240 |
Bath/shower chair |
1,434 |
1,300 |
$2.03M |
| E2311 |
Electro connect btw 2 sys |
1,509 |
1,295 |
$1.86M |
| E2300 |
Pwr seat elevation sys |
849 |
672 |
$1.56M |
| E1002 |
Pwr seat tilt |
499 |
434 |
$1.25M |
| E1161 |
Manual adult wc w tiltinspac |
2,533 |
2,305 |
$1.22M |
| E0973 |
W/ch access det adj armrest |
6,514 |
5,389 |
$1.01M |
| E2620 |
Wc planar back cush wd <22in |
2,517 |
2,088 |
$944K |
| E1012 |
Ctr mount pwr elev leg rest |
1,284 |
1,021 |
$795K |
| A9900 |
Supply/accessory/service |
8,687 |
6,935 |
$735K |
| E0955 |
Cushioned headrest |
6,632 |
5,488 |
$639K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,743 |
2,372 |
$635K |
| E2363 |
Gr24 sealed leadacid battery |
2,704 |
2,173 |
$571K |
| E2370 |
Pwr wc dr wh motor/gear comb |
682 |
509 |
$546K |
| E2374 |
Hand/chin ctrl std joystick |
1,855 |
1,417 |
$509K |
| E2622 |
Adj skin pro w/c cus wd<22in |
2,134 |
1,829 |
$478K |
| K0040 |
Adjustable angle footplate |
4,125 |
3,548 |
$425K |
| E2361 |
22nf sealed leadacid battery |
2,972 |
2,266 |
$418K |
| E1236 |
Folding ped wc adjustable |
237 |
218 |
$349K |
| E0956 |
W/c lateral trunk/hip suppor |
2,559 |
2,148 |
$348K |
| K0856 |
Pwc gp3 std sing pow opt s/b |
74 |
68 |
$308K |
| E2386 |
Foam filled drive wheel tire |
2,594 |
1,945 |
$301K |
| E2377 |
Expandable controller, initl |
1,233 |
1,042 |
$299K |
| E0950 |
Tray |
1,956 |
1,713 |
$298K |
| E2613 |
Position back cush wd <22in |
910 |
837 |
$293K |
| E2366 |
Battery charger, single mode |
2,116 |
1,600 |
$273K |
| A4351 |
Straight tip urine catheter |
1,968 |
1,595 |
$270K |
| T5001 |
Position seat spec orth need |
227 |
216 |
$264K |
| E2392 |
Solid caster tire, integrate |
3,678 |
2,814 |
$264K |
| A4554 |
Disposable underpads |
6,054 |
5,682 |
$248K |
| E0986 |
Man w/c powr assist syst |
173 |
139 |
$242K |
| E2298 |
Pwr seat elev sys for crt |
167 |
127 |
$239K |
| E0960 |
W/c shoulder harness/straps |
3,008 |
2,766 |
$222K |
| E2313 |
Pwc harness, expand control |
1,251 |
1,063 |
$207K |
| E0971 |
Wheelchair anti-tipping devi |
4,237 |
3,732 |
$203K |
| E0978 |
W/c acc,saf belt pelv strap |
5,562 |
4,810 |
$171K |
| E2624 |
Adj skin pro/pos cus<22in |
721 |
597 |
$168K |
| E2394 |
Drive wheel excludes tire |
2,830 |
2,099 |
$168K |
| E8000 |
Posterior gait trainer |
81 |
76 |
$164K |
| A4927 |
Non-sterile gloves |
7,658 |
6,732 |
$152K |
| E2211 |
Pneumatic propulsion tire |
2,651 |
2,317 |
$114K |
| K0823 |
Pwc gp 2 std cap chair |
1,094 |
891 |
$114K |
| E2213 |
Pneumatic prop tire insert |
2,516 |
2,190 |
$84K |
| A4314 |
Cath w/drainage 2-way latex |
3,617 |
3,300 |
$76K |
| E2615 |
Pos back post/lat wdth <22in |
241 |
208 |
$75K |
| E2206 |
Man wc whl lock comp repl ea |
1,255 |
1,031 |
$61K |
| K0849 |
Pwc gp 3 std cap chair |
14 |
12 |
$58K |
| E2611 |
Gen use back cush wdth <22in |
297 |
246 |
$58K |
| E0961 |
Wheelchair brake extension |
2,111 |
1,874 |
$57K |
| E0951 |
Loop heel |
2,767 |
2,350 |
$56K |
| A4333 |
Urinary cath anchor device |
2,540 |
2,164 |
$49K |
| E0953 |
W/c lateral thigh/knee sup |
684 |
457 |
$44K |
| K0019 |
Arm pad repl, each |
2,970 |
2,367 |
$42K |
| E2231 |
Solid seat support base |
456 |
406 |
$41K |
| E2205 |
Manual wc accessory, handrim |
516 |
364 |
$40K |
| K0899 |
Pow mobil dev no dmepdac |
21 |
19 |
$38K |
| K0821 |
Pwc gp 2 std port cap chair |
104 |
99 |
$37K |
| K0038 |
Leg strap each |
1,855 |
1,678 |
$35K |
| T4527 |
Adult size pull-on lg |
164 |
159 |
$29K |
| A4402 |
Lubricant per ounce |
5,123 |
4,711 |
$28K |
| A4358 |
Urinary leg or abdomen bag |
4,628 |
4,188 |
$28K |
| K0077 |
Fr cstr asmb sol tire rep ea |
342 |
305 |
$27K |
| A4357 |
Bedside drainage bag |
3,397 |
3,023 |
$25K |
| T4535 |
Disposable liner/shield/pad |
462 |
449 |
$23K |
| E2619 |
Replace cover w/c seat cush |
1,342 |
1,114 |
$22K |
| A4349 |
Disposable male external cat |
588 |
512 |
$22K |
| E2359 |
Gr34 sealed leadacid battery |
159 |
119 |
$20K |
| K0017 |
Detach adjust armrest base |
349 |
270 |
$17K |
| A4245 |
Alcohol wipes per box |
1,665 |
1,572 |
$16K |
| E1235 |
Rigid ped wc adjustable |
12 |
12 |
$15K |
| E2617 |
Custom fab w/c back cushion |
21 |
12 |
$13K |
| E0952 |
Toe loop/holder, each |
522 |
490 |
$12K |
| K0004 |
High strength ltwt whlchr |
100 |
91 |
$12K |
| A6212 |
Foam drg <=16 sq in w/border |
44 |
39 |
$11K |
| A4409 |
Ost skn barr convex <=4 sq i |
118 |
102 |
$11K |
| K0070 |
Rr whl compl pne tire rep ea |
46 |
37 |
$11K |
| E2210 |
Wheelchair bearings |
939 |
697 |
$10K |
| A4320 |
Irrigation tray |
2,190 |
2,024 |
$10K |
| A4385 |
Ost skn barrier sld ext wear |
198 |
176 |
$10K |
| A5120 |
Skin barrier, wipe or swab |
1,448 |
1,327 |
$9K |
| T4526 |
Adult size pull-on med |
74 |
70 |
$9K |
| E0630 |
Patient lift hydraulic |
42 |
37 |
$8K |
| K0018 |
Detach adjust armrst upper |
294 |
240 |
$8K |
| E2609 |
Custom fabricate w/c cushion |
15 |
12 |
$8K |
| E2601 |
Gen w/c cushion wdth < 22 in |
164 |
145 |
$8K |
| E2365 |
U1 sealed leadacid battery |
55 |
50 |
$6K |
| E2224 |
Propulsion whl excl tire rep |
45 |
40 |
$4K |
| A4456 |
Adhesive remover, wipes |
565 |
505 |
$4K |
| E2209 |
Arm trough each |
30 |
24 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
906 |
774 |
$3K |
| T4522 |
Adult size brief/diaper med |
37 |
36 |
$3K |
| A4452 |
Waterproof tape |
346 |
297 |
$3K |
| E0990 |
Wheelchair elevating leg res |
14 |
13 |
$2K |
| E2603 |
Skin protect wc cus wd <22in |
14 |
12 |
$1K |
| E0992 |
Wheelchair solid seat insert |
107 |
99 |
$1K |
| E0981 |
Seat upholstery, replacement |
30 |
28 |
$1K |
| E2390 |
Solid drive wheel tire |
27 |
25 |
$1K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$987.06 |
| A4394 |
Ostomy pouch liq deodorant |
48 |
41 |
$794.57 |
| E2395 |
Caster wheel excludes tire |
16 |
14 |
$728.58 |
| K0043 |
Ftrst lowr exten tube rep ea |
39 |
24 |
$698.21 |
| A4406 |
Pectin based ostomy paste |
28 |
26 |
$618.38 |
| A4322 |
Irrigation syringe |
157 |
152 |
$616.25 |
| E2323 |
Special joystick handle |
14 |
14 |
$609.68 |
| E0966 |
Wheelchair head rest extensi |
16 |
13 |
$578.52 |
| A4425 |
Ost pch drain for barrier fl |
15 |
12 |
$477.88 |
| A4371 |
Skin barrier powder per oz |
66 |
63 |
$209.34 |
| A4334 |
Urinary cath leg strap |
133 |
113 |
$200.98 |
| A4217 |
Sterile water/saline, 500 ml |
15 |
12 |
$99.74 |
| A4332 |
Lube sterile packet |
14 |
12 |
$88.70 |
| A9270 |
Non-covered item or service |
71 |
41 |
$0.00 |
| E1340 |
|
39 |
30 |
$0.00 |