| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,789 |
550 |
$888K |
| K0108 |
W/c component-accessory nos |
3,473 |
1,836 |
$392K |
| E1161 |
Manual adult wc w tiltinspac |
1,435 |
1,434 |
$322K |
| E1028 |
W/c manual swingaway |
4,542 |
3,875 |
$255K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,340 |
3,268 |
$113K |
| E0240 |
Bath/shower chair |
66 |
66 |
$94K |
| E0955 |
Cushioned headrest |
2,158 |
2,155 |
$93K |
| E0973 |
W/ch access det adj armrest |
786 |
734 |
$55K |
| K0823 |
Pwc gp 2 std cap chair |
977 |
977 |
$52K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,071 |
1,068 |
$49K |
| E0630 |
Patient lift hydraulic |
595 |
595 |
$38K |
| K0040 |
Adjustable angle footplate |
275 |
264 |
$23K |
| E2607 |
Skin pro/pos wc cus wd <22in |
110 |
110 |
$21K |
| E0971 |
Wheelchair anti-tipping devi |
366 |
362 |
$19K |
| K0004 |
High strength ltwt whlchr |
464 |
464 |
$17K |
| E2617 |
Custom fab w/c back cushion |
12 |
12 |
$16K |
| E0978 |
W/c acc,saf belt pelv strap |
692 |
688 |
$14K |
| E0960 |
W/c shoulder harness/straps |
205 |
205 |
$14K |
| E2213 |
Pneumatic prop tire insert |
246 |
246 |
$8K |
| E2211 |
Pneumatic propulsion tire |
152 |
152 |
$6K |
| E0956 |
W/c lateral trunk/hip suppor |
27 |
27 |
$4K |
| E0197 |
Air pressure pad for mattres |
277 |
276 |
$3K |
| E0950 |
Tray |
24 |
24 |
$2K |
| K0038 |
Leg strap each |
25 |
25 |
$591.85 |
| E0961 |
Wheelchair brake extension |
12 |
12 |
$379.85 |
| K0825 |
Pwc gp 2 hd cap chair |
12 |
12 |
$330.40 |