| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
11,350 |
2,454 |
$5.66M |
| K0108 |
W/c component-accessory nos |
14,404 |
3,885 |
$2.57M |
| E1161 |
Manual adult wc w tiltinspac |
3,062 |
2,392 |
$597K |
| E1028 |
W/c manual swingaway |
8,001 |
4,817 |
$433K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,473 |
4,292 |
$222K |
| E1007 |
Pwr seat combo w/shear |
79 |
57 |
$202K |
| K0005 |
Ultralightweight wheelchair |
211 |
174 |
$187K |
| E2311 |
Electro connect btw 2 sys |
250 |
187 |
$179K |
| E0955 |
Cushioned headrest |
4,670 |
3,683 |
$161K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
74 |
53 |
$150K |
| E1012 |
Ctr mount pwr elev leg rest |
278 |
211 |
$141K |
| E0973 |
W/ch access det adj armrest |
2,371 |
1,704 |
$107K |
| A6250 |
Skin seal protect moisturizr |
474 |
456 |
$98K |
| K0040 |
Adjustable angle footplate |
1,907 |
1,432 |
$91K |
| E0956 |
W/c lateral trunk/hip suppor |
1,239 |
825 |
$90K |
| E2607 |
Skin pro/pos wc cus wd <22in |
860 |
702 |
$85K |
| E2617 |
Custom fab w/c back cushion |
82 |
67 |
$68K |
| E0960 |
W/c shoulder harness/straps |
1,258 |
1,067 |
$57K |
| E0971 |
Wheelchair anti-tipping devi |
1,880 |
1,352 |
$45K |
| A4554 |
Disposable underpads |
438 |
401 |
$40K |
| T4523 |
Adult size brief/diaper lg |
228 |
218 |
$36K |
| E0978 |
W/c acc,saf belt pelv strap |
2,262 |
1,889 |
$30K |
| K0823 |
Pwc gp 2 std cap chair |
167 |
134 |
$28K |
| E0950 |
Tray |
358 |
293 |
$25K |
| E2377 |
Expandable controller, initl |
155 |
108 |
$24K |
| T4524 |
Adult size brief/diaper xl |
127 |
126 |
$23K |
| E2313 |
Pwc harness, expand control |
174 |
120 |
$19K |
| E0630 |
Patient lift hydraulic |
86 |
75 |
$19K |
| E0260 |
Hosp bed semi-electr w/ matt |
95 |
89 |
$18K |
| A4927 |
Non-sterile gloves |
827 |
796 |
$18K |
| E2609 |
Custom fabricate w/c cushion |
31 |
24 |
$14K |
| E2361 |
22nf sealed leadacid battery |
163 |
118 |
$11K |
| E0951 |
Loop heel |
709 |
498 |
$8K |
| A5120 |
Skin barrier, wipe or swab |
589 |
565 |
$6K |
| E2211 |
Pneumatic propulsion tire |
141 |
112 |
$5K |
| E2620 |
Wc planar back cush wd <22in |
36 |
26 |
$5K |
| E2213 |
Pneumatic prop tire insert |
170 |
118 |
$4K |
| E2219 |
Foam caster tire any size ea |
96 |
72 |
$4K |
| E0240 |
Bath/shower chair |
14 |
14 |
$4K |
| E2231 |
Solid seat support base |
47 |
37 |
$3K |
| E0961 |
Wheelchair brake extension |
118 |
89 |
$3K |
| E2624 |
Adj skin pro/pos cus<22in |
18 |
13 |
$3K |
| T4535 |
Disposable liner/shield/pad |
64 |
60 |
$3K |
| E2615 |
Pos back post/lat wdth <22in |
16 |
12 |
$2K |
| E2622 |
Adj skin pro w/c cus wd<22in |
20 |
14 |
$2K |
| E2386 |
Foam filled drive wheel tire |
22 |
13 |
$2K |
| T4522 |
Adult size brief/diaper med |
17 |
14 |
$2K |
| K0019 |
Arm pad repl, each |
97 |
58 |
$984.24 |
| E2394 |
Drive wheel excludes tire |
23 |
13 |
$762.61 |
| E2206 |
Man wc whl lock comp repl ea |
21 |
16 |
$731.39 |
| E2392 |
Solid caster tire, integrate |
23 |
12 |
$561.37 |
| K0038 |
Leg strap each |
15 |
12 |
$234.92 |