| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,839 |
1,839 |
$274K |
| E2510 |
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
26 |
26 |
$109K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
2,243 |
2,117 |
$57K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
893 |
628 |
$50K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,943 |
1,932 |
$31K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
61 |
61 |
$30K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
44 |
44 |
$23K |
| K0040 |
Adjustable angle footplate, each |
455 |
368 |
$21K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
462 |
377 |
$13K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
132 |
131 |
$6K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,827 |
2,055 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
274 |
199 |
$5K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
137 |
113 |
$4K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
261 |
213 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
311 |
307 |
$2K |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
73 |
61 |
$2K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
42 |
27 |
$2K |
| K0019 |
Arm pad, replacement only, each |
102 |
76 |
$710.91 |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
13 |
13 |
$698.19 |
| K0077 |
Front caster assembly, complete, with solid tire, replacement only, each |
23 |
14 |
$465.62 |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
27 |
12 |
$256.88 |