| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
20,380 |
11,909 |
$3.34M |
| E1399 |
Durable medical equipment mi |
4,137 |
1,838 |
$2.14M |
| E1161 |
Manual adult wc w tiltinspac |
9,663 |
9,451 |
$2.04M |
| K0739 |
Repair/svc dme non-oxygen eq |
20,219 |
18,162 |
$1.95M |
| E1007 |
Pwr seat combo w/shear |
437 |
391 |
$1.68M |
| K0005 |
Ultralightweight wheelchair |
1,570 |
1,420 |
$1.36M |
| E0240 |
Bath/shower chair |
566 |
542 |
$1.13M |
| E2311 |
Electro connect btw 2 sys |
1,146 |
1,048 |
$1.12M |
| E1028 |
W/c manual swingaway |
18,441 |
15,338 |
$1.06M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
301 |
243 |
$694K |
| K0823 |
Pwc gp 2 std cap chair |
2,264 |
2,166 |
$515K |
| E0973 |
W/ch access det adj armrest |
5,779 |
4,484 |
$434K |
| E0955 |
Cushioned headrest |
12,060 |
11,542 |
$402K |
| E1012 |
Ctr mount pwr elev leg rest |
799 |
706 |
$396K |
| E2361 |
22nf sealed leadacid battery |
2,678 |
2,524 |
$383K |
| E2620 |
Wc planar back cush wd <22in |
1,407 |
1,307 |
$373K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,142 |
2,036 |
$326K |
| E0956 |
W/c lateral trunk/hip suppor |
2,867 |
2,199 |
$286K |
| E1002 |
Pwr seat tilt |
142 |
127 |
$256K |
| K0040 |
Adjustable angle footplate |
4,605 |
3,534 |
$254K |
| E2615 |
Pos back post/lat wdth <22in |
999 |
910 |
$243K |
| E2622 |
Adj skin pro w/c cus wd<22in |
1,474 |
1,378 |
$241K |
| E1236 |
Folding ped wc adjustable |
511 |
493 |
$228K |
| E0971 |
Wheelchair anti-tipping devi |
4,411 |
3,372 |
$168K |
| E2377 |
Expandable controller, initl |
707 |
632 |
$158K |
| K0800 |
Pov group 1 std up to 300lbs |
440 |
425 |
$151K |
| E2617 |
Custom fab w/c back cushion |
252 |
232 |
$147K |
| E2374 |
Hand/chin ctrl std joystick |
569 |
516 |
$145K |
| E2313 |
Pwc harness, expand control |
749 |
680 |
$121K |
| E2203 |
Frame depth less than 22 in |
390 |
350 |
$102K |
| E0978 |
W/c acc,saf belt pelv strap |
4,763 |
4,534 |
$102K |
| E2231 |
Solid seat support base |
1,227 |
1,185 |
$101K |
| E0960 |
W/c shoulder harness/straps |
1,765 |
1,676 |
$97K |
| E2211 |
Pneumatic propulsion tire |
2,313 |
1,663 |
$79K |
| K0070 |
Rr whl compl pne tire rep ea |
482 |
405 |
$78K |
| E2386 |
Foam filled drive wheel tire |
486 |
427 |
$70K |
| E2213 |
Pneumatic prop tire insert |
2,509 |
1,887 |
$69K |
| E2624 |
Adj skin pro/pos cus<22in |
328 |
302 |
$66K |
| E2611 |
Gen use back cush wdth <22in |
554 |
533 |
$63K |
| E0961 |
Wheelchair brake extension |
2,352 |
1,804 |
$61K |
| E2394 |
Drive wheel excludes tire |
871 |
734 |
$60K |
| E2613 |
Position back cush wd <22in |
287 |
264 |
$57K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
267 |
260 |
$57K |
| E2206 |
Man wc whl lock comp repl ea |
1,348 |
1,030 |
$51K |
| E2366 |
Battery charger, single mode |
431 |
394 |
$50K |
| E0950 |
Tray |
749 |
705 |
$50K |
| E2363 |
Gr24 sealed leadacid battery |
239 |
212 |
$47K |
| E0951 |
Loop heel |
3,335 |
2,515 |
$44K |
| E2392 |
Solid caster tire, integrate |
538 |
472 |
$43K |
| E2370 |
Pwr wc dr wh motor/gear comb |
89 |
63 |
$43K |
| E2395 |
Caster wheel excludes tire |
474 |
432 |
$36K |
| K0077 |
Fr cstr asmb sol tire rep ea |
547 |
463 |
$34K |
| K0019 |
Arm pad repl, each |
2,369 |
1,912 |
$33K |
| E0986 |
Man w/c powr assist syst |
43 |
36 |
$29K |
| E2365 |
U1 sealed leadacid battery |
284 |
275 |
$24K |
| E1225 |
Manual semi-reclining back |
366 |
342 |
$15K |
| E0635 |
Patient lift electric |
249 |
241 |
$14K |
| E0260 |
Hosp bed semi-electr w/ matt |
296 |
296 |
$14K |
| K0195 |
Elevating whlchair leg rests |
2,178 |
2,107 |
$14K |
| E2609 |
Custom fabricate w/c cushion |
41 |
40 |
$12K |
| E2219 |
Foam caster tire any size ea |
272 |
215 |
$12K |
| K0821 |
Pwc gp 2 std port cap chair |
30 |
28 |
$12K |
| K0801 |
Pov group 1 hd 301-450 lbs |
15 |
15 |
$11K |
| E2601 |
Gen w/c cushion wdth < 22 in |
375 |
343 |
$11K |
| E2389 |
Foam caster tire |
238 |
221 |
$11K |
| K0806 |
Pov group 2 std up to 300lbs |
15 |
14 |
$10K |
| E0990 |
Wheelchair elevating leg res |
61 |
48 |
$6K |
| E2310 |
Electro connect btw control |
12 |
12 |
$6K |
| E2210 |
Wheelchair bearings |
498 |
465 |
$6K |
| K0004 |
High strength ltwt whlchr |
122 |
90 |
$6K |
| E0992 |
Wheelchair solid seat insert |
137 |
131 |
$4K |
| K0038 |
Leg strap each |
181 |
164 |
$2K |
| E0954 |
Foot box, any type each foot |
60 |
39 |
$2K |
| E0952 |
Toe loop/holder, each |
83 |
55 |
$1K |
| K0733 |
12-24hr sealed lead acid |
52 |
51 |
$1K |
| K0043 |
Ftrst lowr exten tube rep ea |
29 |
24 |
$565.61 |
| E0995 |
Wc calf rest, pad replacemnt |
12 |
12 |
$180.96 |
| E2207 |
Crutch and cane holder |
17 |
12 |
$171.90 |
| A9901 |
Delivery/set up/dispensing |
135 |
126 |
$171.46 |