| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2510 |
Sgd w multi methods msg/accs |
934 |
933 |
$4.46M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
913 |
899 |
$2.24M |
| E1161 |
Manual adult wc w tiltinspac |
10,743 |
10,707 |
$1.59M |
| E1007 |
Pwr seat combo w/shear |
481 |
478 |
$1.35M |
| K0823 |
Pwc gp 2 std cap chair |
3,439 |
3,401 |
$1.32M |
| K0005 |
Ultralightweight wheelchair |
1,391 |
1,377 |
$1.20M |
| K0108 |
W/c component-accessory nos |
7,278 |
5,167 |
$1.03M |
| E1399 |
Durable medical equipment mi |
542 |
491 |
$726K |
| K0739 |
Repair/svc dme non-oxygen eq |
14,515 |
13,964 |
$607K |
| E2311 |
Electro connect btw 2 sys |
769 |
762 |
$504K |
| E1012 |
Ctr mount pwr elev leg rest |
951 |
943 |
$499K |
| K0825 |
Pwc gp 2 hd cap chair |
808 |
799 |
$363K |
| E0955 |
Cushioned headrest |
12,358 |
12,287 |
$347K |
| E1028 |
W/c manual swingaway |
15,771 |
13,002 |
$315K |
| E2620 |
Wc planar back cush wd <22in |
1,515 |
1,467 |
$311K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,032 |
1,981 |
$275K |
| E1002 |
Pwr seat tilt |
153 |
152 |
$254K |
| E2374 |
Hand/chin ctrl std joystick |
1,211 |
1,201 |
$250K |
| K0040 |
Adjustable angle footplate |
4,175 |
3,606 |
$242K |
| E0956 |
W/c lateral trunk/hip suppor |
1,987 |
1,711 |
$196K |
| E2361 |
22nf sealed leadacid battery |
1,703 |
1,681 |
$174K |
| E0973 |
W/ch access det adj armrest |
3,704 |
3,153 |
$171K |
| E2377 |
Expandable controller, initl |
712 |
702 |
$161K |
| E2617 |
Custom fab w/c back cushion |
203 |
201 |
$157K |
| E2622 |
Adj skin pro w/c cus wd<22in |
1,033 |
1,011 |
$140K |
| E0971 |
Wheelchair anti-tipping devi |
3,550 |
3,336 |
$133K |
| E2613 |
Position back cush wd <22in |
549 |
541 |
$122K |
| E2366 |
Battery charger, single mode |
1,202 |
1,197 |
$118K |
| E0960 |
W/c shoulder harness/straps |
2,185 |
2,107 |
$113K |
| E2313 |
Pwc harness, expand control |
702 |
692 |
$111K |
| E2392 |
Solid caster tire, integrate |
1,562 |
1,473 |
$106K |
| E2386 |
Foam filled drive wheel tire |
1,047 |
985 |
$101K |
| K0856 |
Pwc gp3 std sing pow opt s/b |
37 |
37 |
$89K |
| E2213 |
Pneumatic prop tire insert |
2,940 |
2,757 |
$78K |
| E2394 |
Drive wheel excludes tire |
1,263 |
1,203 |
$77K |
| E0950 |
Tray |
765 |
757 |
$71K |
| E2611 |
Gen use back cush wdth <22in |
660 |
658 |
$69K |
| E2370 |
Pwr wc dr wh motor/gear comb |
154 |
124 |
$60K |
| E2359 |
Gr34 sealed leadacid battery |
375 |
372 |
$55K |
| E2211 |
Pneumatic propulsion tire |
2,603 |
2,484 |
$52K |
| E0953 |
W/c lateral thigh/knee sup |
769 |
705 |
$52K |
| E2615 |
Pos back post/lat wdth <22in |
240 |
231 |
$48K |
| A4351 |
Straight tip urine catheter |
316 |
308 |
$42K |
| K0800 |
Pov group 1 std up to 300lbs |
65 |
64 |
$41K |
| E0951 |
Loop heel |
2,482 |
2,322 |
$41K |
| E2231 |
Solid seat support base |
1,004 |
1,002 |
$41K |
| E2624 |
Adj skin pro/pos cus<22in |
262 |
259 |
$39K |
| E2206 |
Man wc whl lock comp repl ea |
1,314 |
1,002 |
$37K |
| E2298 |
Pwr seat elev sys for crt |
50 |
49 |
$37K |
| E2609 |
Custom fabricate w/c cushion |
71 |
69 |
$34K |
| E2363 |
Gr24 sealed leadacid battery |
259 |
256 |
$33K |
| E0978 |
W/c acc,saf belt pelv strap |
2,824 |
2,806 |
$32K |
| E2365 |
U1 sealed leadacid battery |
463 |
456 |
$31K |
| K0019 |
Arm pad repl, each |
1,946 |
1,786 |
$25K |
| E0961 |
Wheelchair brake extension |
1,481 |
1,382 |
$24K |
| E2300 |
Pwr seat elevation sys |
26 |
26 |
$23K |
| K0004 |
High strength ltwt whlchr |
515 |
514 |
$22K |
| E0986 |
Man w/c powr assist syst |
43 |
43 |
$21K |
| E2203 |
Frame depth less than 22 in |
119 |
119 |
$21K |
| E2599 |
Sgd accessory noc |
12 |
12 |
$18K |
| K0077 |
Fr cstr asmb sol tire rep ea |
417 |
411 |
$16K |
| E1236 |
Folding ped wc adjustable |
14 |
14 |
$15K |
| E2601 |
Gen w/c cushion wdth < 22 in |
574 |
573 |
$13K |
| K0003 |
Lightweight wheelchair |
391 |
390 |
$12K |
| A4353 |
Intermittent urinary cath |
24 |
24 |
$9K |
| E0630 |
Patient lift hydraulic |
70 |
65 |
$8K |
| K0070 |
Rr whl compl pne tire rep ea |
222 |
167 |
$7K |
| E2205 |
Manual wc accessory, handrim |
271 |
260 |
$6K |
| K0821 |
Pwc gp 2 std port cap chair |
14 |
14 |
$6K |
| E0952 |
Toe loop/holder, each |
268 |
259 |
$4K |
| E2619 |
Replace cover w/c seat cush |
186 |
176 |
$4K |
| E2210 |
Wheelchair bearings |
467 |
440 |
$3K |
| K0038 |
Leg strap each |
211 |
208 |
$3K |
| E1225 |
Manual semi-reclining back |
39 |
39 |
$3K |
| E2323 |
Special joystick handle |
93 |
90 |
$2K |
| E0957 |
W/c medial thigh support |
29 |
28 |
$2K |
| E0954 |
Foot box, any type each foot |
37 |
37 |
$2K |
| K0052 |
Swingaway detach ftrest repl |
15 |
12 |
$1K |
| K0043 |
Ftrst lowr exten tube rep ea |
90 |
80 |
$1K |
| E2603 |
Skin protect wc cus wd <22in |
28 |
24 |
$1K |
| E2395 |
Caster wheel excludes tire |
18 |
17 |
$1K |
| K0195 |
Elevating whlchair leg rests |
1,130 |
1,096 |
$1K |
| K0462 |
Temporary replacement eqpmnt |
12 |
12 |
$579.60 |
| E2389 |
Foam caster tire |
14 |
12 |
$336.82 |
| K0018 |
Detach adjust armrst upper |
13 |
12 |
$172.63 |