| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
1,785 |
597 |
$954K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
3,696 |
1,862 |
$710K |
| S9999 |
Sales tax |
2,638 |
2,057 |
$452K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
512 |
324 |
$282K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,954 |
1,285 |
$209K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
2,289 |
2,091 |
$203K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,418 |
1,060 |
$80K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
354 |
297 |
$42K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
169 |
142 |
$11K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
344 |
330 |
$10K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
58 |
52 |
$10K |
| K0040 |
Adjustable angle footplate, each |
108 |
84 |
$10K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
56 |
38 |
$8K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
26 |
26 |
$6K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
16 |
12 |
$6K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
46 |
44 |
$6K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
52 |
50 |
$6K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
58 |
55 |
$4K |
| K0038 |
Leg strap, each |
12 |
12 |
$249.87 |