| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
845 |
256 |
$181K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,746 |
1,517 |
$104K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
26 |
24 |
$100K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
616 |
431 |
$93K |
| A4554 |
Disposable underpads, all sizes |
3,082 |
2,953 |
$93K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
30 |
28 |
$51K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
41 |
39 |
$49K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
392 |
376 |
$49K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
27 |
25 |
$36K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,014 |
959 |
$36K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
290 |
281 |
$28K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
142 |
108 |
$24K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
141 |
141 |
$22K |
| K0005 |
Ultralightweight wheelchair |
30 |
26 |
$17K |
| A4335 |
Incontinence supply; miscellaneous |
3,155 |
3,051 |
$16K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
13 |
13 |
$9K |
| K0040 |
Adjustable angle footplate, each |
228 |
156 |
$7K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
27 |
25 |
$6K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
123 |
97 |
$6K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
14 |
13 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
230 |
141 |
$5K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
27 |
25 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
491 |
478 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
201 |
201 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
210 |
125 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
285 |
215 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
374 |
342 |
$2K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
16 |
12 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
21 |
13 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
129 |
114 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
105 |
68 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
38 |
38 |
$1K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
62 |
56 |
$868.19 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
88 |
56 |
$746.13 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
87 |
57 |
$551.21 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
24 |
24 |
$465.39 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
44 |
27 |
$181.39 |