| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
9,353 |
1,816 |
$4.58M |
| K0108 |
W/c component-accessory nos |
7,074 |
2,090 |
$1.20M |
| E1028 |
W/c manual swingaway |
4,018 |
1,798 |
$380K |
| E0955 |
Cushioned headrest |
1,684 |
1,066 |
$110K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,518 |
1,709 |
$88K |
| E0973 |
W/ch access det adj armrest |
961 |
600 |
$47K |
| E0960 |
W/c shoulder harness/straps |
914 |
556 |
$43K |
| E0956 |
W/c lateral trunk/hip suppor |
481 |
228 |
$38K |
| K0040 |
Adjustable angle footplate |
537 |
362 |
$25K |
| E0978 |
W/c acc,saf belt pelv strap |
1,290 |
881 |
$17K |
| E0971 |
Wheelchair anti-tipping devi |
607 |
402 |
$17K |
| E2617 |
Custom fab w/c back cushion |
14 |
12 |
$9K |
| E0950 |
Tray |
94 |
67 |
$4K |
| E2613 |
Position back cush wd <22in |
17 |
13 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
22 |
12 |
$2K |
| E0951 |
Loop heel |
93 |
62 |
$2K |
| E2213 |
Pneumatic prop tire insert |
47 |
36 |
$1K |
| E0952 |
Toe loop/holder, each |
24 |
12 |
$269.80 |