| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
1,234 |
998 |
$5.56M |
| A4353 |
Intermittent urinary cath |
5,880 |
4,838 |
$4.92M |
| E1399 |
Durable medical equipment mi |
3,366 |
1,873 |
$4.64M |
| K0108 |
W/c component-accessory nos |
10,846 |
6,431 |
$2.13M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
729 |
575 |
$1.86M |
| E2311 |
Electro connect btw 2 sys |
1,314 |
1,058 |
$1.33M |
| E1028 |
W/c manual swingaway |
12,212 |
8,046 |
$1.15M |
| E1161 |
Manual adult wc w tiltinspac |
3,671 |
2,607 |
$1.00M |
| K0005 |
Ultralightweight wheelchair |
894 |
709 |
$878K |
| E1012 |
Ctr mount pwr elev leg rest |
966 |
757 |
$537K |
| K0823 |
Pwc gp 2 std cap chair |
4,231 |
3,577 |
$512K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,230 |
1,904 |
$355K |
| E0973 |
W/ch access det adj armrest |
3,492 |
2,770 |
$340K |
| A4554 |
Disposable underpads |
6,273 |
5,283 |
$334K |
| E0956 |
W/c lateral trunk/hip suppor |
2,542 |
1,913 |
$320K |
| E1002 |
Pwr seat tilt |
254 |
203 |
$317K |
| E2620 |
Wc planar back cush wd <22in |
1,302 |
1,044 |
$313K |
| K0739 |
Repair/svc dme non-oxygen eq |
8,380 |
7,100 |
$273K |
| E2359 |
Gr34 sealed leadacid battery |
1,168 |
952 |
$212K |
| E2377 |
Expandable controller, initl |
891 |
707 |
$205K |
| E0955 |
Cushioned headrest |
4,274 |
3,500 |
$201K |
| K0825 |
Pwc gp 2 hd cap chair |
881 |
764 |
$200K |
| K0040 |
Adjustable angle footplate |
2,689 |
2,108 |
$198K |
| E2313 |
Pwc harness, expand control |
955 |
750 |
$180K |
| E2361 |
22nf sealed leadacid battery |
1,828 |
1,529 |
$179K |
| E0971 |
Wheelchair anti-tipping devi |
2,647 |
2,140 |
$125K |
| T4522 |
Adult size brief/diaper med |
1,000 |
897 |
$111K |
| E0960 |
W/c shoulder harness/straps |
1,736 |
1,449 |
$107K |
| E2622 |
Adj skin pro w/c cus wd<22in |
556 |
427 |
$90K |
| A4351 |
Straight tip urine catheter |
1,014 |
754 |
$87K |
| E2617 |
Custom fab w/c back cushion |
83 |
53 |
$85K |
| E2211 |
Pneumatic propulsion tire |
1,976 |
1,533 |
$82K |
| E2392 |
Solid caster tire, integrate |
1,502 |
1,094 |
$81K |
| A4927 |
Non-sterile gloves |
4,460 |
3,772 |
$74K |
| E0978 |
W/c acc,saf belt pelv strap |
2,838 |
2,355 |
$65K |
| E2374 |
Hand/chin ctrl std joystick |
315 |
253 |
$60K |
| E2386 |
Foam filled drive wheel tire |
583 |
464 |
$58K |
| E2613 |
Position back cush wd <22in |
259 |
220 |
$58K |
| E2300 |
Pwr seat elevation sys |
33 |
25 |
$55K |
| T4530 |
Ped size brief/diaper lg |
612 |
547 |
$53K |
| E2394 |
Drive wheel excludes tire |
792 |
601 |
$43K |
| E2624 |
Adj skin pro/pos cus<22in |
258 |
211 |
$38K |
| E0950 |
Tray |
552 |
448 |
$36K |
| T4526 |
Adult size pull-on med |
245 |
215 |
$23K |
| E2365 |
U1 sealed leadacid battery |
313 |
274 |
$19K |
| E2231 |
Solid seat support base |
209 |
166 |
$16K |
| K0019 |
Arm pad repl, each |
1,252 |
1,017 |
$15K |
| E2363 |
Gr24 sealed leadacid battery |
95 |
75 |
$14K |
| E2611 |
Gen use back cush wdth <22in |
112 |
91 |
$14K |
| E2298 |
Pwr seat elev sys for crt |
38 |
26 |
$12K |
| E0951 |
Loop heel |
648 |
507 |
$11K |
| A4349 |
Disposable male external cat |
314 |
230 |
$11K |
| E2213 |
Pneumatic prop tire insert |
357 |
294 |
$9K |
| T4527 |
Adult size pull-on lg |
83 |
72 |
$9K |
| A4357 |
Bedside drainage bag |
714 |
556 |
$6K |
| E2366 |
Battery charger, single mode |
64 |
56 |
$5K |
| K0038 |
Leg strap each |
306 |
240 |
$4K |
| W4132 |
|
267 |
230 |
$4K |
| K0017 |
Detach adjust armrest base |
96 |
65 |
$4K |
| A4335 |
Incontinence supply |
483 |
393 |
$3K |
| E0953 |
W/c lateral thigh/knee sup |
82 |
61 |
$3K |
| K0821 |
Pwc gp 2 std port cap chair |
13 |
12 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
305 |
243 |
$2K |
| T4534 |
Youth size pull-on |
16 |
12 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
56 |
41 |
$1K |
| E0961 |
Wheelchair brake extension |
15 |
13 |
$498.15 |
| E2323 |
Special joystick handle |
12 |
12 |
$356.25 |