| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
15,261 |
8,269 |
$3.00M |
| E1399 |
Durable medical equipment mi |
5,674 |
2,336 |
$2.76M |
| K0739 |
Repair/svc dme non-oxygen eq |
13,013 |
11,569 |
$1.35M |
| E1161 |
Manual adult wc w tiltinspac |
5,969 |
5,899 |
$1.25M |
| E1028 |
W/c manual swingaway |
10,586 |
9,024 |
$900K |
| E0240 |
Bath/shower chair |
394 |
323 |
$629K |
| K0005 |
Ultralightweight wheelchair |
390 |
349 |
$434K |
| E0955 |
Cushioned headrest |
7,825 |
7,645 |
$305K |
| E0973 |
W/ch access det adj armrest |
2,938 |
2,398 |
$279K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,253 |
1,206 |
$224K |
| E0956 |
W/c lateral trunk/hip suppor |
1,987 |
1,557 |
$215K |
| E2617 |
Custom fab w/c back cushion |
289 |
270 |
$192K |
| K0040 |
Adjustable angle footplate |
2,653 |
2,178 |
$169K |
| E2622 |
Adj skin pro w/c cus wd<22in |
659 |
634 |
$137K |
| E0960 |
W/c shoulder harness/straps |
2,191 |
2,118 |
$135K |
| E0971 |
Wheelchair anti-tipping devi |
2,470 |
2,004 |
$111K |
| E0978 |
W/c acc,saf belt pelv strap |
3,079 |
2,979 |
$76K |
| E2211 |
Pneumatic propulsion tire |
1,706 |
1,377 |
$71K |
| E0950 |
Tray |
1,025 |
995 |
$62K |
| E2213 |
Pneumatic prop tire insert |
1,795 |
1,467 |
$60K |
| E2231 |
Solid seat support base |
662 |
647 |
$57K |
| E2361 |
22nf sealed leadacid battery |
325 |
293 |
$50K |
| E2386 |
Foam filled drive wheel tire |
281 |
252 |
$47K |
| E2620 |
Wc planar back cush wd <22in |
158 |
146 |
$46K |
| E2609 |
Custom fabricate w/c cushion |
71 |
68 |
$39K |
| E0961 |
Wheelchair brake extension |
1,085 |
861 |
$31K |
| E2392 |
Solid caster tire, integrate |
282 |
256 |
$25K |
| K0070 |
Rr whl compl pne tire rep ea |
111 |
105 |
$24K |
| E0951 |
Loop heel |
1,336 |
1,100 |
$21K |
| E2206 |
Man wc whl lock comp repl ea |
438 |
393 |
$21K |
| E2394 |
Drive wheel excludes tire |
227 |
206 |
$21K |
| K0019 |
Arm pad repl, each |
1,119 |
1,034 |
$19K |
| E2311 |
Electro connect btw 2 sys |
16 |
15 |
$18K |
| E1236 |
Folding ped wc adjustable |
14 |
14 |
$18K |
| E2374 |
Hand/chin ctrl std joystick |
56 |
54 |
$18K |
| E2619 |
Replace cover w/c seat cush |
568 |
538 |
$13K |
| E2613 |
Position back cush wd <22in |
45 |
44 |
$12K |
| K0077 |
Fr cstr asmb sol tire rep ea |
138 |
134 |
$11K |
| E2370 |
Pwr wc dr wh motor/gear comb |
15 |
12 |
$10K |
| E1012 |
Ctr mount pwr elev leg rest |
15 |
14 |
$7K |
| E2615 |
Pos back post/lat wdth <22in |
24 |
24 |
$6K |
| E2624 |
Adj skin pro/pos cus<22in |
26 |
26 |
$5K |
| E2377 |
Expandable controller, initl |
14 |
13 |
$3K |
| E2219 |
Foam caster tire any size ea |
56 |
51 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
14 |
12 |
$2K |
| E2313 |
Pwc harness, expand control |
15 |
14 |
$2K |
| K0195 |
Elevating whlchair leg rests |
97 |
92 |
$1K |
| E0952 |
Toe loop/holder, each |
61 |
49 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
14 |
14 |
$962.38 |
| E2601 |
Gen w/c cushion wdth < 22 in |
26 |
25 |
$549.45 |
| K0038 |
Leg strap each |
28 |
28 |
$351.82 |
| E2210 |
Wheelchair bearings |
25 |
25 |
$323.88 |