| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
5,966 |
828 |
$1.52M |
| K0108 |
W/c component-accessory nos |
10,045 |
2,548 |
$665K |
| E1161 |
Manual adult wc w tiltinspac |
2,979 |
2,265 |
$571K |
| E1028 |
W/c manual swingaway |
11,210 |
4,829 |
$469K |
| K0823 |
Pwc gp 2 std cap chair |
3,447 |
2,443 |
$242K |
| E0955 |
Cushioned headrest |
5,145 |
3,346 |
$177K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,973 |
2,963 |
$121K |
| E0973 |
W/ch access det adj armrest |
4,413 |
1,956 |
$121K |
| K0005 |
Ultralightweight wheelchair |
195 |
94 |
$120K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,099 |
614 |
$91K |
| K0040 |
Adjustable angle footplate |
2,736 |
1,191 |
$87K |
| E2311 |
Electro connect btw 2 sys |
144 |
76 |
$76K |
| E0971 |
Wheelchair anti-tipping devi |
2,995 |
1,316 |
$56K |
| E1012 |
Ctr mount pwr elev leg rest |
222 |
122 |
$55K |
| K0825 |
Pwc gp 2 hd cap chair |
553 |
351 |
$55K |
| E2361 |
22nf sealed leadacid battery |
881 |
446 |
$44K |
| E0960 |
W/c shoulder harness/straps |
732 |
410 |
$33K |
| E2620 |
Wc planar back cush wd <22in |
254 |
119 |
$33K |
| E0240 |
Bath/shower chair |
33 |
12 |
$31K |
| E0956 |
W/c lateral trunk/hip suppor |
475 |
196 |
$26K |
| E0978 |
W/c acc,saf belt pelv strap |
2,164 |
1,217 |
$25K |
| E0950 |
Tray |
187 |
105 |
$10K |
| K0003 |
Lightweight wheelchair |
576 |
406 |
$9K |
| E2231 |
Solid seat support base |
164 |
82 |
$8K |
| E2613 |
Position back cush wd <22in |
68 |
27 |
$8K |
| E0630 |
Patient lift hydraulic |
203 |
164 |
$8K |
| E0986 |
Man w/c powr assist syst |
16 |
12 |
$5K |
| E0951 |
Loop heel |
558 |
229 |
$4K |
| E2377 |
Expandable controller, initl |
23 |
12 |
$4K |
| E2213 |
Pneumatic prop tire insert |
278 |
111 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
28 |
14 |
$3K |
| E2313 |
Pwc harness, expand control |
23 |
12 |
$3K |
| E2211 |
Pneumatic propulsion tire |
157 |
67 |
$3K |
| K0195 |
Elevating whlchair leg rests |
499 |
395 |
$2K |
| E0961 |
Wheelchair brake extension |
162 |
63 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
39 |
15 |
$2K |
| E2365 |
U1 sealed leadacid battery |
35 |
24 |
$1K |
| E2219 |
Foam caster tire any size ea |
40 |
14 |
$910.80 |
| E2392 |
Solid caster tire, integrate |
38 |
14 |
$296.32 |