| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,344 |
977 |
$3.60M |
| K0108 |
W/c component-accessory nos |
3,457 |
2,793 |
$1.10M |
| E1007 |
Pwr seat combo w/shear |
106 |
97 |
$424K |
| E1028 |
W/c manual swingaway |
2,592 |
2,354 |
$422K |
| K0823 |
Pwc gp 2 std cap chair |
822 |
809 |
$222K |
| E1161 |
Manual adult wc w tiltinspac |
290 |
278 |
$159K |
| E2311 |
Electro connect btw 2 sys |
128 |
117 |
$139K |
| E0955 |
Cushioned headrest |
1,365 |
1,326 |
$127K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
39 |
36 |
$121K |
| E0973 |
W/ch access det adj armrest |
1,293 |
1,227 |
$100K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,075 |
3,795 |
$88K |
| E1012 |
Ctr mount pwr elev leg rest |
98 |
94 |
$78K |
| E0956 |
W/c lateral trunk/hip suppor |
588 |
541 |
$72K |
| K0040 |
Adjustable angle footplate |
843 |
781 |
$65K |
| E2361 |
22nf sealed leadacid battery |
552 |
532 |
$58K |
| E0971 |
Wheelchair anti-tipping devi |
821 |
786 |
$51K |
| E2620 |
Wc planar back cush wd <22in |
150 |
141 |
$41K |
| E0960 |
W/c shoulder harness/straps |
672 |
647 |
$39K |
| E2392 |
Solid caster tire, integrate |
639 |
610 |
$39K |
| E2607 |
Skin pro/pos wc cus wd <22in |
209 |
196 |
$36K |
| E0978 |
W/c acc,saf belt pelv strap |
1,134 |
1,104 |
$32K |
| E2377 |
Expandable controller, initl |
110 |
101 |
$26K |
| E0950 |
Tray |
291 |
281 |
$24K |
| E2386 |
Foam filled drive wheel tire |
173 |
164 |
$17K |
| K0005 |
Ultralightweight wheelchair |
14 |
13 |
$17K |
| E2211 |
Pneumatic propulsion tire |
364 |
350 |
$16K |
| E2213 |
Pneumatic prop tire insert |
376 |
355 |
$15K |
| E2313 |
Pwc harness, expand control |
70 |
66 |
$13K |
| E2394 |
Drive wheel excludes tire |
253 |
246 |
$12K |
| E2363 |
Gr24 sealed leadacid battery |
52 |
50 |
$11K |
| E0951 |
Loop heel |
332 |
313 |
$8K |
| K0019 |
Arm pad repl, each |
466 |
454 |
$7K |
| E2366 |
Battery charger, single mode |
42 |
42 |
$5K |
| E2231 |
Solid seat support base |
41 |
40 |
$4K |
| E2374 |
Hand/chin ctrl std joystick |
15 |
13 |
$994.48 |
| E0953 |
W/c lateral thigh/knee sup |
16 |
14 |
$974.17 |