| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,140 |
952 |
$1.68M |
| K0108 |
W/c component-accessory nos |
3,826 |
1,485 |
$505K |
| K0005 |
Ultralightweight wheelchair |
169 |
169 |
$250K |
| E1028 |
W/c manual swingaway |
3,125 |
2,509 |
$249K |
| K0823 |
Pwc gp 2 std cap chair |
1,151 |
1,150 |
$151K |
| E0240 |
Bath/shower chair |
97 |
97 |
$150K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,173 |
2,135 |
$95K |
| E0955 |
Cushioned headrest |
1,148 |
1,148 |
$87K |
| E1007 |
Pwr seat combo w/shear |
25 |
25 |
$87K |
| E0973 |
W/ch access det adj armrest |
1,251 |
1,080 |
$81K |
| E2607 |
Skin pro/pos wc cus wd <22in |
355 |
355 |
$63K |
| K0040 |
Adjustable angle footplate |
720 |
648 |
$54K |
| E0971 |
Wheelchair anti-tipping devi |
818 |
706 |
$37K |
| E2311 |
Electro connect btw 2 sys |
37 |
37 |
$35K |
| E0260 |
Hosp bed semi-electr w/ matt |
595 |
594 |
$31K |
| E0956 |
W/c lateral trunk/hip suppor |
185 |
172 |
$28K |
| E0960 |
W/c shoulder harness/straps |
346 |
346 |
$27K |
| E2613 |
Position back cush wd <22in |
93 |
93 |
$25K |
| E1161 |
Manual adult wc w tiltinspac |
143 |
143 |
$24K |
| E1012 |
Ctr mount pwr elev leg rest |
27 |
27 |
$16K |
| E0978 |
W/c acc,saf belt pelv strap |
635 |
633 |
$13K |
| E2211 |
Pneumatic propulsion tire |
255 |
218 |
$11K |
| E2622 |
Adj skin pro w/c cus wd<22in |
50 |
50 |
$10K |
| E2213 |
Pneumatic prop tire insert |
216 |
182 |
$8K |
| E2611 |
Gen use back cush wdth <22in |
53 |
53 |
$7K |
| E2361 |
22nf sealed leadacid battery |
63 |
63 |
$6K |
| E0635 |
Patient lift electric |
63 |
63 |
$6K |
| E0950 |
Tray |
90 |
90 |
$6K |
| K0821 |
Pwc gp 2 std port cap chair |
12 |
12 |
$6K |
| E2377 |
Expandable controller, initl |
26 |
26 |
$5K |
| E2313 |
Pwc harness, expand control |
26 |
26 |
$4K |
| E0630 |
Patient lift hydraulic |
92 |
92 |
$4K |
| E2359 |
Gr34 sealed leadacid battery |
12 |
12 |
$3K |
| A9901 |
Delivery/set up/dispensing |
24 |
24 |
$3K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$3K |
| E2365 |
U1 sealed leadacid battery |
27 |
27 |
$1K |
| E2219 |
Foam caster tire any size ea |
16 |
14 |
$907.12 |
| E0961 |
Wheelchair brake extension |
31 |
27 |
$715.05 |
| K0825 |
Pwc gp 2 hd cap chair |
13 |
13 |
$434.08 |
| E0951 |
Loop heel |
15 |
12 |
$223.50 |