| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,474 |
1,072 |
$1.13M |
| K0108 |
W/c component-accessory nos |
9,213 |
4,708 |
$1.01M |
| E1028 |
W/c manual swingaway |
9,483 |
5,965 |
$736K |
| K0739 |
Repair/svc dme non-oxygen eq |
11,361 |
9,481 |
$610K |
| E1161 |
Manual adult wc w tiltinspac |
2,615 |
2,261 |
$590K |
| K0005 |
Ultralightweight wheelchair |
432 |
356 |
$481K |
| K0823 |
Pwc gp 2 std cap chair |
1,990 |
1,671 |
$350K |
| E0986 |
Man w/c powr assist syst |
482 |
387 |
$337K |
| A9900 |
Supply/accessory/service |
1,610 |
1,256 |
$310K |
| E0955 |
Cushioned headrest |
4,284 |
3,815 |
$241K |
| E0973 |
W/ch access det adj armrest |
3,028 |
2,230 |
$222K |
| E2607 |
Skin pro/pos wc cus wd <22in |
988 |
847 |
$204K |
| E1012 |
Ctr mount pwr elev leg rest |
600 |
395 |
$188K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
57 |
41 |
$156K |
| E1007 |
Pwr seat combo w/shear |
58 |
38 |
$154K |
| E0956 |
W/c lateral trunk/hip suppor |
1,253 |
882 |
$123K |
| E2361 |
22nf sealed leadacid battery |
1,125 |
927 |
$120K |
| K0040 |
Adjustable angle footplate |
2,024 |
1,576 |
$115K |
| T4541 |
Large disposable underpad |
2,561 |
2,352 |
$109K |
| E2311 |
Electro connect btw 2 sys |
116 |
89 |
$101K |
| K0821 |
Pwc gp 2 std port cap chair |
363 |
295 |
$78K |
| E0971 |
Wheelchair anti-tipping devi |
1,791 |
1,460 |
$76K |
| E0960 |
W/c shoulder harness/straps |
1,328 |
1,132 |
$72K |
| E0978 |
W/c acc,saf belt pelv strap |
2,606 |
2,221 |
$59K |
| T4526 |
Adult size pull-on med |
485 |
453 |
$54K |
| E2613 |
Position back cush wd <22in |
187 |
169 |
$50K |
| E2620 |
Wc planar back cush wd <22in |
185 |
145 |
$48K |
| E2392 |
Solid caster tire, integrate |
798 |
611 |
$46K |
| E2622 |
Adj skin pro w/c cus wd<22in |
146 |
118 |
$34K |
| E2213 |
Pneumatic prop tire insert |
1,002 |
834 |
$32K |
| T4522 |
Adult size brief/diaper med |
285 |
276 |
$32K |
| E2313 |
Pwc harness, expand control |
116 |
91 |
$27K |
| E0951 |
Loop heel |
1,049 |
842 |
$26K |
| E2211 |
Pneumatic propulsion tire |
701 |
567 |
$26K |
| E2617 |
Custom fab w/c back cushion |
30 |
24 |
$21K |
| E2374 |
Hand/chin ctrl std joystick |
108 |
93 |
$21K |
| A4351 |
Straight tip urine catheter |
111 |
104 |
$19K |
| E2386 |
Foam filled drive wheel tire |
227 |
190 |
$18K |
| E2609 |
Custom fabricate w/c cushion |
41 |
28 |
$18K |
| K0019 |
Arm pad repl, each |
1,268 |
1,011 |
$17K |
| E2366 |
Battery charger, single mode |
131 |
107 |
$13K |
| E2394 |
Drive wheel excludes tire |
318 |
256 |
$13K |
| E0950 |
Tray |
170 |
140 |
$12K |
| E2206 |
Man wc whl lock comp repl ea |
377 |
249 |
$10K |
| E2377 |
Expandable controller, initl |
58 |
42 |
$10K |
| T4535 |
Disposable liner/shield/pad |
137 |
132 |
$9K |
| E2231 |
Solid seat support base |
72 |
64 |
$6K |
| E0961 |
Wheelchair brake extension |
185 |
147 |
$6K |
| E2615 |
Pos back post/lat wdth <22in |
18 |
16 |
$5K |
| E2365 |
U1 sealed leadacid battery |
75 |
56 |
$5K |
| E2363 |
Gr24 sealed leadacid battery |
30 |
24 |
$5K |
| T4528 |
Adult size pull-on xl |
24 |
24 |
$4K |
| K0070 |
Rr whl compl pne tire rep ea |
12 |
12 |
$3K |
| T4527 |
Adult size pull-on lg |
25 |
24 |
$3K |
| K0004 |
High strength ltwt whlchr |
16 |
12 |
$3K |
| T4524 |
Adult size brief/diaper xl |
13 |
12 |
$2K |
| K0195 |
Elevating whlchair leg rests |
116 |
80 |
$1K |
| K0052 |
Swingaway detach ftrest repl |
18 |
12 |
$816.08 |
| E0953 |
W/c lateral thigh/knee sup |
22 |
12 |
$802.93 |
| K0077 |
Fr cstr asmb sol tire rep ea |
17 |
12 |
$771.98 |
| E2205 |
Manual wc accessory, handrim |
13 |
13 |
$679.76 |
| K0043 |
Ftrst lowr exten tube rep ea |
21 |
14 |
$265.02 |
| E0952 |
Toe loop/holder, each |
17 |
12 |
$245.99 |
| A4927 |
Non-sterile gloves |
12 |
12 |
$212.91 |
| E2210 |
Wheelchair bearings |
14 |
12 |
$108.10 |