| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,378 |
1,107 |
$2.01M |
| E1007 |
Pwr seat combo w/shear |
218 |
189 |
$1.09M |
| K0108 |
W/c component-accessory nos |
7,494 |
3,015 |
$1.05M |
| E2617 |
Custom fab w/c back cushion |
383 |
328 |
$540K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
112 |
95 |
$472K |
| E2609 |
Custom fabricate w/c cushion |
276 |
230 |
$472K |
| E1028 |
W/c manual swingaway |
5,960 |
3,256 |
$422K |
| E2311 |
Electro connect btw 2 sys |
246 |
209 |
$317K |
| E0240 |
Bath/shower chair |
212 |
196 |
$265K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,534 |
4,055 |
$213K |
| E0955 |
Cushioned headrest |
2,878 |
2,632 |
$182K |
| E1161 |
Manual adult wc w tiltinspac |
899 |
881 |
$180K |
| E1012 |
Ctr mount pwr elev leg rest |
200 |
176 |
$117K |
| E2607 |
Skin pro/pos wc cus wd <22in |
444 |
383 |
$106K |
| E0973 |
W/ch access det adj armrest |
1,141 |
914 |
$87K |
| K0040 |
Adjustable angle footplate |
1,097 |
895 |
$77K |
| E2377 |
Expandable controller, initl |
241 |
208 |
$71K |
| E0960 |
W/c shoulder harness/straps |
1,064 |
910 |
$59K |
| E2313 |
Pwc harness, expand control |
240 |
207 |
$47K |
| K0823 |
Pwc gp 2 std cap chair |
262 |
259 |
$47K |
| E0950 |
Tray |
667 |
563 |
$47K |
| E2620 |
Wc planar back cush wd <22in |
110 |
95 |
$46K |
| E0956 |
W/c lateral trunk/hip suppor |
396 |
255 |
$38K |
| E0971 |
Wheelchair anti-tipping devi |
768 |
656 |
$36K |
| A9900 |
Supply/accessory/service |
104 |
14 |
$34K |
| 97542 |
|
991 |
426 |
$27K |
| E2300 |
Pwr seat elevation sys |
13 |
12 |
$26K |
| E0978 |
W/c acc,saf belt pelv strap |
1,188 |
1,034 |
$23K |
| E2213 |
Pneumatic prop tire insert |
543 |
464 |
$21K |
| E2211 |
Pneumatic propulsion tire |
179 |
144 |
$7K |
| E2613 |
Position back cush wd <22in |
14 |
14 |
$4K |
| E0953 |
W/c lateral thigh/knee sup |
33 |
27 |
$4K |
| E0961 |
Wheelchair brake extension |
89 |
71 |
$2K |
| E2361 |
22nf sealed leadacid battery |
16 |
12 |
$2K |
| E0951 |
Loop heel |
133 |
101 |
$2K |
| E2619 |
Replace cover w/c seat cush |
32 |
29 |
$757.66 |
| E2206 |
Man wc whl lock comp repl ea |
15 |
12 |
$660.29 |
| K0038 |
Leg strap each |
18 |
16 |
$286.90 |
| K0019 |
Arm pad repl, each |
15 |
12 |
$127.99 |