| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
5,839 |
2,020 |
$2.29M |
| K0108 |
W/c component-accessory nos |
10,302 |
5,483 |
$2.25M |
| E0240 |
Bath/shower chair |
643 |
627 |
$1.66M |
| E1161 |
Manual adult wc w tiltinspac |
5,170 |
5,125 |
$1.06M |
| K0739 |
Repair/svc dme non-oxygen eq |
8,280 |
7,547 |
$831K |
| E1028 |
W/c manual swingaway |
10,069 |
8,792 |
$615K |
| K0005 |
Ultralightweight wheelchair |
605 |
597 |
$450K |
| E1007 |
Pwr seat combo w/shear |
71 |
68 |
$322K |
| E0955 |
Cushioned headrest |
7,674 |
7,544 |
$238K |
| E0973 |
W/ch access det adj armrest |
3,092 |
2,308 |
$229K |
| E2617 |
Custom fab w/c back cushion |
403 |
372 |
$197K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
50 |
50 |
$186K |
| E2311 |
Electro connect btw 2 sys |
136 |
134 |
$184K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,124 |
1,080 |
$179K |
| K0040 |
Adjustable angle footplate |
3,035 |
2,262 |
$155K |
| E0971 |
Wheelchair anti-tipping devi |
2,758 |
2,027 |
$93K |
| E0956 |
W/c lateral trunk/hip suppor |
773 |
580 |
$83K |
| E0960 |
W/c shoulder harness/straps |
1,440 |
1,390 |
$81K |
| E2211 |
Pneumatic propulsion tire |
1,896 |
1,375 |
$63K |
| E0978 |
W/c acc,saf belt pelv strap |
2,827 |
2,753 |
$59K |
| E2213 |
Pneumatic prop tire insert |
2,024 |
1,501 |
$53K |
| E2615 |
Pos back post/lat wdth <22in |
242 |
241 |
$52K |
| E2622 |
Adj skin pro w/c cus wd<22in |
267 |
259 |
$46K |
| E1012 |
Ctr mount pwr elev leg rest |
71 |
68 |
$42K |
| E2361 |
22nf sealed leadacid battery |
242 |
239 |
$40K |
| E2231 |
Solid seat support base |
441 |
432 |
$36K |
| K0823 |
Pwc gp 2 std cap chair |
121 |
121 |
$34K |
| E0961 |
Wheelchair brake extension |
1,399 |
959 |
$29K |
| E2203 |
Frame depth less than 22 in |
113 |
112 |
$24K |
| E0950 |
Tray |
258 |
251 |
$24K |
| E2377 |
Expandable controller, initl |
70 |
70 |
$21K |
| E2611 |
Gen use back cush wdth <22in |
212 |
211 |
$21K |
| E1236 |
Folding ped wc adjustable |
16 |
16 |
$20K |
| E0951 |
Loop heel |
1,607 |
1,187 |
$20K |
| E2313 |
Pwc harness, expand control |
70 |
70 |
$15K |
| E2620 |
Wc planar back cush wd <22in |
50 |
49 |
$14K |
| K0195 |
Elevating whlchair leg rests |
1,989 |
1,972 |
$12K |
| E0990 |
Wheelchair elevating leg res |
164 |
111 |
$12K |
| E2609 |
Custom fabricate w/c cushion |
29 |
27 |
$11K |
| E2219 |
Foam caster tire any size ea |
132 |
99 |
$5K |
| K0019 |
Arm pad repl, each |
369 |
330 |
$5K |
| E2206 |
Man wc whl lock comp repl ea |
141 |
103 |
$4K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
13 |
13 |
$3K |
| E0966 |
Wheelchair head rest extensi |
14 |
14 |
$816.65 |
| E0952 |
Toe loop/holder, each |
22 |
15 |
$387.94 |
| E2601 |
Gen w/c cushion wdth < 22 in |
35 |
35 |
$318.41 |
| A9901 |
Delivery/set up/dispensing |
14 |
14 |
$42.00 |
| A9270 |
Non-covered item or service |
27 |
27 |
$0.00 |