| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
2,132 |
1,759 |
$121K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,686 |
1,494 |
$59K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
13 |
12 |
$34K |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
971 |
574 |
$29K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,549 |
801 |
$16K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
246 |
105 |
$12K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
335 |
244 |
$10K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
13 |
12 |
$9K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
158 |
85 |
$5K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
209 |
115 |
$5K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
211 |
116 |
$4K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
159 |
85 |
$3K |
| E2396 |
Power wheelchair accessory, caster fork, any size, replacement only, each |
159 |
91 |
$2K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
65 |
55 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
841 |
722 |
$2K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
13 |
12 |
$2K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
13 |
12 |
$1K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
25 |
12 |
$212.91 |
| K0815 |
Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
12 |
12 |
$204.94 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
25 |
12 |
$75.70 |