| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,940 |
2,363 |
$4.23M |
| K0108 |
W/c component-accessory nos |
14,628 |
9,822 |
$3.28M |
| E2617 |
Custom fab w/c back cushion |
1,601 |
1,330 |
$1.68M |
| E1161 |
Manual adult wc w tiltinspac |
4,389 |
3,906 |
$1.12M |
| K0739 |
Repair/svc dme non-oxygen eq |
18,572 |
15,077 |
$1.11M |
| E1028 |
W/c manual swingaway |
11,102 |
7,445 |
$883K |
| E2609 |
Custom fabricate w/c cushion |
814 |
722 |
$843K |
| E1007 |
Pwr seat combo w/shear |
205 |
164 |
$773K |
| E0986 |
Man w/c powr assist syst |
587 |
518 |
$530K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
208 |
165 |
$519K |
| E2300 |
Pwr seat elevation sys |
347 |
250 |
$514K |
| E2311 |
Electro connect btw 2 sys |
457 |
384 |
$469K |
| K0005 |
Ultralightweight wheelchair |
397 |
333 |
$372K |
| E0955 |
Cushioned headrest |
6,750 |
5,912 |
$355K |
| E0956 |
W/c lateral trunk/hip suppor |
3,231 |
2,082 |
$311K |
| E0973 |
W/ch access det adj armrest |
3,635 |
2,748 |
$300K |
| A4353 |
Intermittent urinary cath |
391 |
357 |
$251K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,680 |
1,418 |
$230K |
| E0960 |
W/c shoulder harness/straps |
3,572 |
2,924 |
$195K |
| E1012 |
Ctr mount pwr elev leg rest |
335 |
293 |
$185K |
| K0040 |
Adjustable angle footplate |
2,986 |
2,399 |
$169K |
| E2374 |
Hand/chin ctrl std joystick |
706 |
606 |
$161K |
| E0971 |
Wheelchair anti-tipping devi |
2,896 |
2,349 |
$116K |
| E2361 |
22nf sealed leadacid battery |
865 |
729 |
$97K |
| E0950 |
Tray |
1,489 |
1,191 |
$95K |
| E0978 |
W/c acc,saf belt pelv strap |
4,115 |
3,504 |
$86K |
| E1236 |
Folding ped wc adjustable |
71 |
66 |
$79K |
| E2377 |
Expandable controller, initl |
310 |
260 |
$69K |
| K0070 |
Rr whl compl pne tire rep ea |
381 |
322 |
$60K |
| E2313 |
Pwc harness, expand control |
402 |
333 |
$59K |
| E2213 |
Pneumatic prop tire insert |
2,374 |
1,948 |
$59K |
| E2211 |
Pneumatic propulsion tire |
1,739 |
1,420 |
$59K |
| E2392 |
Solid caster tire, integrate |
1,431 |
948 |
$59K |
| E2386 |
Foam filled drive wheel tire |
454 |
384 |
$51K |
| T4541 |
Large disposable underpad |
999 |
865 |
$50K |
| E2620 |
Wc planar back cush wd <22in |
224 |
189 |
$45K |
| E0951 |
Loop heel |
2,431 |
1,979 |
$44K |
| E2363 |
Gr24 sealed leadacid battery |
299 |
237 |
$44K |
| E2624 |
Adj skin pro/pos cus<22in |
292 |
234 |
$41K |
| E2394 |
Drive wheel excludes tire |
789 |
646 |
$41K |
| E2206 |
Man wc whl lock comp repl ea |
1,081 |
784 |
$34K |
| E0953 |
W/c lateral thigh/knee sup |
401 |
267 |
$27K |
| K0019 |
Arm pad repl, each |
2,016 |
1,651 |
$24K |
| E2231 |
Solid seat support base |
314 |
271 |
$23K |
| E2366 |
Battery charger, single mode |
231 |
180 |
$21K |
| E0952 |
Toe loop/holder, each |
993 |
799 |
$20K |
| K0077 |
Fr cstr asmb sol tire rep ea |
349 |
296 |
$18K |
| K0823 |
Pwc gp 2 std cap chair |
118 |
56 |
$16K |
| E2298 |
Pwr seat elev sys for crt |
13 |
12 |
$15K |
| E2359 |
Gr34 sealed leadacid battery |
107 |
85 |
$15K |
| K0821 |
Pwc gp 2 std port cap chair |
184 |
130 |
$12K |
| E2615 |
Pos back post/lat wdth <22in |
73 |
51 |
$11K |
| E2622 |
Adj skin pro w/c cus wd<22in |
86 |
77 |
$11K |
| E2370 |
Pwr wc dr wh motor/gear comb |
26 |
12 |
$10K |
| A4927 |
Non-sterile gloves |
626 |
496 |
$7K |
| E0240 |
Bath/shower chair |
13 |
12 |
$5K |
| E0961 |
Wheelchair brake extension |
156 |
118 |
$3K |
| A4351 |
Straight tip urine catheter |
32 |
26 |
$3K |
| E2619 |
Replace cover w/c seat cush |
115 |
93 |
$3K |
| E2205 |
Manual wc accessory, handrim |
63 |
56 |
$2K |
| E0966 |
Wheelchair head rest extensi |
41 |
37 |
$2K |
| K0072 |
Fr cstr semi-pne tire rep ea |
27 |
25 |
$1K |
| E2395 |
Caster wheel excludes tire |
23 |
13 |
$1K |
| E0957 |
W/c medial thigh support |
16 |
12 |
$1K |
| K0018 |
Detach adjust armrst upper |
79 |
52 |
$1K |
| K0038 |
Leg strap each |
32 |
27 |
$368.56 |
| K0195 |
Elevating whlchair leg rests |
61 |
60 |
$166.01 |
| E2210 |
Wheelchair bearings |
17 |
14 |
$121.36 |