| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
850 |
288 |
$1.38M |
| K0108 |
W/c component-accessory nos |
5,261 |
1,905 |
$917K |
| E1007 |
Pwr seat combo w/shear |
196 |
114 |
$404K |
| E1028 |
W/c manual swingaway |
3,286 |
2,101 |
$334K |
| K0823 |
Pwc gp 2 std cap chair |
1,257 |
1,059 |
$255K |
| E2311 |
Electro connect btw 2 sys |
289 |
191 |
$224K |
| E1161 |
Manual adult wc w tiltinspac |
411 |
328 |
$195K |
| E1012 |
Ctr mount pwr elev leg rest |
306 |
204 |
$188K |
| E2617 |
Custom fab w/c back cushion |
155 |
101 |
$150K |
| E2609 |
Custom fabricate w/c cushion |
129 |
89 |
$96K |
| E0973 |
W/ch access det adj armrest |
1,162 |
863 |
$96K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,070 |
2,297 |
$95K |
| E0955 |
Cushioned headrest |
1,431 |
1,054 |
$93K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
62 |
38 |
$88K |
| E2361 |
22nf sealed leadacid battery |
612 |
444 |
$71K |
| K0040 |
Adjustable angle footplate |
830 |
538 |
$46K |
| E0956 |
W/c lateral trunk/hip suppor |
380 |
271 |
$38K |
| K0005 |
Ultralightweight wheelchair |
36 |
26 |
$33K |
| E2377 |
Expandable controller, initl |
264 |
154 |
$31K |
| E2313 |
Pwc harness, expand control |
235 |
137 |
$29K |
| E2620 |
Wc planar back cush wd <22in |
157 |
99 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
611 |
441 |
$27K |
| E0260 |
Hosp bed semi-electr w/ matt |
489 |
446 |
$26K |
| E2300 |
Pwr seat elevation sys |
22 |
14 |
$20K |
| E2607 |
Skin pro/pos wc cus wd <22in |
172 |
114 |
$18K |
| E0960 |
W/c shoulder harness/straps |
324 |
236 |
$16K |
| K0003 |
Lightweight wheelchair |
303 |
296 |
$16K |
| E0978 |
W/c acc,saf belt pelv strap |
638 |
497 |
$14K |
| E2365 |
U1 sealed leadacid battery |
179 |
145 |
$13K |
| E2613 |
Position back cush wd <22in |
58 |
41 |
$13K |
| E2211 |
Pneumatic propulsion tire |
272 |
199 |
$10K |
| K0001 |
Standard wheelchair |
189 |
177 |
$9K |
| E0951 |
Loop heel |
418 |
175 |
$4K |
| E2213 |
Pneumatic prop tire insert |
124 |
85 |
$4K |
| E0630 |
Patient lift hydraulic |
64 |
62 |
$3K |
| E0953 |
W/c lateral thigh/knee sup |
31 |
12 |
$3K |
| E2394 |
Drive wheel excludes tire |
44 |
28 |
$2K |
| E0961 |
Wheelchair brake extension |
67 |
40 |
$1K |
| E2231 |
Solid seat support base |
14 |
13 |
$1K |
| E2395 |
Caster wheel excludes tire |
32 |
24 |
$1K |
| K0019 |
Arm pad repl, each |
108 |
85 |
$1K |
| E2374 |
Hand/chin ctrl std joystick |
22 |
15 |
$968.18 |
| E2386 |
Foam filled drive wheel tire |
17 |
12 |
$963.50 |
| K0195 |
Elevating whlchair leg rests |
191 |
168 |
$885.87 |
| E0950 |
Tray |
16 |
12 |
$781.40 |
| E2210 |
Wheelchair bearings |
29 |
25 |
$207.76 |