| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,844 |
916 |
$2.50M |
| K0108 |
W/c component-accessory nos |
5,079 |
2,267 |
$632K |
| E1028 |
W/c manual swingaway |
4,469 |
2,256 |
$360K |
| A4353 |
Intermittent urinary cath |
446 |
353 |
$269K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,110 |
3,232 |
$123K |
| E0955 |
Cushioned headrest |
2,075 |
1,596 |
$98K |
| E1161 |
Manual adult wc w tiltinspac |
311 |
259 |
$76K |
| K0823 |
Pwc gp 2 std cap chair |
700 |
631 |
$56K |
| E1012 |
Ctr mount pwr elev leg rest |
217 |
171 |
$43K |
| E0973 |
W/ch access det adj armrest |
416 |
292 |
$23K |
| E2311 |
Electro connect btw 2 sys |
20 |
14 |
$12K |
| E0960 |
W/c shoulder harness/straps |
189 |
131 |
$11K |
| E2620 |
Wc planar back cush wd <22in |
42 |
31 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
389 |
308 |
$6K |
| E2622 |
Adj skin pro w/c cus wd<22in |
39 |
25 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
68 |
31 |
$5K |
| A4351 |
Straight tip urine catheter |
43 |
37 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
28 |
24 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
77 |
64 |
$3K |
| K0040 |
Adjustable angle footplate |
48 |
37 |
$3K |
| E2392 |
Solid caster tire, integrate |
57 |
39 |
$2K |
| E2211 |
Pneumatic propulsion tire |
87 |
64 |
$2K |
| E2363 |
Gr24 sealed leadacid battery |
20 |
13 |
$1K |
| T4541 |
Large disposable underpad |
67 |
56 |
$1K |
| E0950 |
Tray |
19 |
12 |
$678.28 |
| A4927 |
Non-sterile gloves |
82 |
55 |
$280.53 |
| K0019 |
Arm pad repl, each |
32 |
25 |
$266.29 |
| E0951 |
Loop heel |
25 |
12 |
$193.97 |
| A9286 |
Any hygienic item, device |
19 |
12 |
$23.26 |