| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
9,404 |
3,336 |
$833K |
| E1161 |
Manual adult wc w tiltinspac |
2,434 |
2,244 |
$512K |
| E2617 |
Custom fab w/c back cushion |
452 |
360 |
$348K |
| E1028 |
W/c manual swingaway |
5,513 |
3,749 |
$314K |
| E2609 |
Custom fabricate w/c cushion |
399 |
326 |
$277K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,206 |
4,228 |
$270K |
| K0823 |
Pwc gp 2 std cap chair |
1,075 |
1,061 |
$184K |
| E0955 |
Cushioned headrest |
3,654 |
3,241 |
$159K |
| E1399 |
Durable medical equipment mi |
757 |
183 |
$156K |
| E0973 |
W/ch access det adj armrest |
1,408 |
1,021 |
$120K |
| E0601 |
Cont airway pressure device |
2,467 |
2,456 |
$111K |
| T4527 |
Adult size pull-on lg |
1,075 |
1,045 |
$87K |
| E1390 |
Oxygen concentrator |
1,678 |
1,667 |
$68K |
| K0040 |
Adjustable angle footplate |
936 |
684 |
$64K |
| T4542 |
Small disposable underpad |
1,796 |
1,726 |
$56K |
| T4535 |
Disposable liner/shield/pad |
1,333 |
1,257 |
$55K |
| E0956 |
W/c lateral trunk/hip suppor |
593 |
417 |
$54K |
| E0960 |
W/c shoulder harness/straps |
1,018 |
840 |
$50K |
| T4526 |
Adult size pull-on med |
669 |
621 |
$49K |
| E1236 |
Folding ped wc adjustable |
251 |
251 |
$46K |
| E0470 |
Rad w/o backup non-inv intfc |
469 |
468 |
$41K |
| A7030 |
Cpap full face mask |
807 |
798 |
$38K |
| T4528 |
Adult size pull-on xl |
433 |
421 |
$32K |
| E0978 |
W/c acc,saf belt pelv strap |
1,463 |
1,243 |
$31K |
| K0070 |
Rr whl compl pne tire rep ea |
460 |
368 |
$29K |
| E0971 |
Wheelchair anti-tipping devi |
575 |
417 |
$24K |
| E2213 |
Pneumatic prop tire insert |
831 |
588 |
$21K |
| A7035 |
Pos airway press headgear |
1,041 |
1,017 |
$18K |
| E0260 |
Hosp bed semi-electr w/ matt |
438 |
429 |
$18K |
| K0001 |
Standard wheelchair |
583 |
568 |
$15K |
| A4604 |
Tubing with heating element |
725 |
720 |
$14K |
| E0562 |
Humidifier heated used w pap |
95 |
94 |
$14K |
| A7031 |
Replacement facemask interfa |
515 |
504 |
$13K |
| A4927 |
Non-sterile gloves |
930 |
888 |
$12K |
| E0431 |
Portable gaseous 02 |
767 |
758 |
$8K |
| E2386 |
Foam filled drive wheel tire |
60 |
52 |
$7K |
| E2374 |
Hand/chin ctrl std joystick |
44 |
36 |
$5K |
| E0951 |
Loop heel |
352 |
227 |
$5K |
| E2361 |
22nf sealed leadacid battery |
32 |
29 |
$5K |
| A7034 |
Nasal application device |
134 |
134 |
$4K |
| E2206 |
Man wc whl lock comp repl ea |
136 |
86 |
$4K |
| K0019 |
Arm pad repl, each |
444 |
292 |
$4K |
| A7038 |
Pos airway pressure filter |
1,592 |
1,572 |
$4K |
| E2394 |
Drive wheel excludes tire |
64 |
52 |
$4K |
| E2211 |
Pneumatic propulsion tire |
115 |
86 |
$4K |
| E2613 |
Position back cush wd <22in |
15 |
12 |
$3K |
| T4543 |
Adult disp brief/diap abv xl |
12 |
12 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
17 |
13 |
$3K |
| A7037 |
Pos airway pressure tubing |
153 |
150 |
$2K |
| E0950 |
Tray |
44 |
36 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
23 |
12 |
$2K |
| T4525 |
Adult size pull-on sm |
24 |
24 |
$2K |
| E2395 |
Caster wheel excludes tire |
30 |
24 |
$2K |
| A7032 |
Replacement nasal cushion |
107 |
107 |
$2K |
| E0952 |
Toe loop/holder, each |
81 |
63 |
$1K |
| E0570 |
Nebulizer with compression |
36 |
36 |
$1K |
| E2210 |
Wheelchair bearings |
105 |
80 |
$873.01 |
| E2219 |
Foam caster tire any size ea |
20 |
15 |
$741.26 |
| E0961 |
Wheelchair brake extension |
17 |
12 |
$324.02 |