| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,305 |
2,035 |
$5.10M |
| K0108 |
W/c component-accessory nos |
4,140 |
2,204 |
$981K |
| E1028 |
W/c manual swingaway |
4,789 |
2,493 |
$540K |
| E1161 |
Manual adult wc w tiltinspac |
500 |
336 |
$180K |
| E0973 |
W/ch access det adj armrest |
1,420 |
1,052 |
$157K |
| E0956 |
W/c lateral trunk/hip suppor |
743 |
579 |
$117K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,231 |
2,480 |
$82K |
| E0960 |
W/c shoulder harness/straps |
1,084 |
968 |
$74K |
| K0040 |
Adjustable angle footplate |
850 |
673 |
$69K |
| E2617 |
Custom fab w/c back cushion |
71 |
62 |
$67K |
| E0971 |
Wheelchair anti-tipping devi |
1,018 |
777 |
$49K |
| E0978 |
W/c acc,saf belt pelv strap |
1,471 |
1,254 |
$39K |
| E2609 |
Custom fabricate w/c cushion |
46 |
42 |
$29K |
| E0950 |
Tray |
356 |
308 |
$28K |
| E0955 |
Cushioned headrest |
805 |
561 |
$18K |
| E0700 |
Safety equipment |
33 |
13 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
44 |
37 |
$9K |
| E2211 |
Pneumatic propulsion tire |
116 |
97 |
$6K |
| K0823 |
Pwc gp 2 std cap chair |
90 |
54 |
$5K |
| E0260 |
Hosp bed semi-electr w/ matt |
62 |
36 |
$5K |
| E2219 |
Foam caster tire any size ea |
78 |
66 |
$4K |
| K0004 |
High strength ltwt whlchr |
89 |
49 |
$4K |
| K0003 |
Lightweight wheelchair |
419 |
259 |
$4K |
| E0951 |
Loop heel |
191 |
137 |
$3K |
| E2213 |
Pneumatic prop tire insert |
62 |
41 |
$2K |
| E2231 |
Solid seat support base |
15 |
13 |
$2K |