| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,361 |
1,125 |
$1.90M |
| K0108 |
W/c component-accessory nos |
3,732 |
2,967 |
$933K |
| E1161 |
Manual adult wc w tiltinspac |
1,889 |
1,886 |
$444K |
| E1028 |
W/c manual swingaway |
5,470 |
4,456 |
$372K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,483 |
4,378 |
$171K |
| E0955 |
Cushioned headrest |
2,898 |
2,896 |
$139K |
| E2607 |
Skin pro/pos wc cus wd <22in |
643 |
642 |
$114K |
| K0823 |
Pwc gp 2 std cap chair |
499 |
498 |
$105K |
| E0973 |
W/ch access det adj armrest |
1,270 |
1,070 |
$99K |
| K0040 |
Adjustable angle footplate |
1,438 |
1,258 |
$91K |
| K0005 |
Ultralightweight wheelchair |
37 |
37 |
$42K |
| E0630 |
Patient lift hydraulic |
540 |
540 |
$33K |
| E0971 |
Wheelchair anti-tipping devi |
808 |
693 |
$33K |
| E0240 |
Bath/shower chair |
12 |
12 |
$27K |
| E0978 |
W/c acc,saf belt pelv strap |
1,221 |
1,221 |
$27K |
| E0960 |
W/c shoulder harness/straps |
348 |
347 |
$23K |
| E1012 |
Ctr mount pwr elev leg rest |
14 |
14 |
$22K |
| E0956 |
W/c lateral trunk/hip suppor |
100 |
93 |
$18K |
| E2311 |
Electro connect btw 2 sys |
12 |
12 |
$13K |
| K0077 |
Fr cstr asmb sol tire rep ea |
148 |
138 |
$12K |
| E2211 |
Pneumatic propulsion tire |
274 |
228 |
$12K |
| E2213 |
Pneumatic prop tire insert |
310 |
276 |
$12K |
| E2377 |
Expandable controller, initl |
12 |
12 |
$4K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$4K |
| E2361 |
22nf sealed leadacid battery |
25 |
25 |
$3K |
| E0950 |
Tray |
25 |
25 |
$2K |
| E2231 |
Solid seat support base |
12 |
12 |
$2K |
| E0951 |
Loop heel |
81 |
68 |
$1K |
| E0961 |
Wheelchair brake extension |
18 |
13 |
$495.76 |
| K0019 |
Arm pad repl, each |
26 |
25 |
$451.71 |