| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
1,124 |
1,008 |
$643K |
| K0108 |
W/c component-accessory nos |
6,623 |
2,883 |
$549K |
| E1161 |
Manual adult wc w tiltinspac |
2,166 |
1,990 |
$509K |
| E2609 |
Custom fabricate w/c cushion |
411 |
349 |
$344K |
| E2617 |
Custom fab w/c back cushion |
347 |
298 |
$324K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,096 |
3,259 |
$198K |
| E1028 |
W/c manual swingaway |
3,425 |
2,606 |
$158K |
| E0601 |
Cont airway pressure device |
2,519 |
2,272 |
$140K |
| K0823 |
Pwc gp 2 std cap chair |
409 |
388 |
$104K |
| E0955 |
Cushioned headrest |
2,673 |
2,384 |
$96K |
| E1390 |
Oxygen concentrator |
1,163 |
1,082 |
$67K |
| E0973 |
W/ch access det adj armrest |
770 |
534 |
$56K |
| A7030 |
Cpap full face mask |
680 |
619 |
$44K |
| T4542 |
Small disposable underpad |
950 |
915 |
$38K |
| T4526 |
Adult size pull-on med |
353 |
336 |
$32K |
| T4527 |
Adult size pull-on lg |
266 |
260 |
$28K |
| K0001 |
Standard wheelchair |
698 |
632 |
$24K |
| E0978 |
W/c acc,saf belt pelv strap |
976 |
784 |
$21K |
| A7035 |
Pos airway press headgear |
909 |
818 |
$16K |
| E0960 |
W/c shoulder harness/straps |
325 |
272 |
$15K |
| A4604 |
Tubing with heating element |
665 |
585 |
$13K |
| E0562 |
Humidifier heated used w pap |
118 |
97 |
$12K |
| A4927 |
Non-sterile gloves |
701 |
685 |
$11K |
| E0470 |
Rad w/o backup non-inv intfc |
78 |
70 |
$10K |
| E0956 |
W/c lateral trunk/hip suppor |
112 |
78 |
$10K |
| K0070 |
Rr whl compl pne tire rep ea |
313 |
194 |
$9K |
| E1399 |
Durable medical equipment mi |
27 |
12 |
$9K |
| A7034 |
Nasal application device |
275 |
243 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
148 |
105 |
$6K |
| E2361 |
22nf sealed leadacid battery |
42 |
38 |
$5K |
| K0040 |
Adjustable angle footplate |
58 |
52 |
$5K |
| A7038 |
Pos airway pressure filter |
2,132 |
1,831 |
$5K |
| E0950 |
Tray |
102 |
78 |
$4K |
| A7031 |
Replacement facemask interfa |
203 |
174 |
$4K |
| E2394 |
Drive wheel excludes tire |
42 |
36 |
$3K |
| E2386 |
Foam filled drive wheel tire |
16 |
12 |
$2K |
| A7032 |
Replacement nasal cushion |
160 |
127 |
$2K |
| T4528 |
Adult size pull-on xl |
14 |
14 |
$2K |
| A7037 |
Pos airway pressure tubing |
117 |
111 |
$2K |
| K0019 |
Arm pad repl, each |
181 |
119 |
$2K |
| E2395 |
Caster wheel excludes tire |
36 |
24 |
$2K |
| E0431 |
Portable gaseous 02 |
86 |
73 |
$1K |
| T4535 |
Disposable liner/shield/pad |
27 |
27 |
$1K |
| E2211 |
Pneumatic propulsion tire |
38 |
25 |
$1K |
| E2213 |
Pneumatic prop tire insert |
32 |
26 |
$932.90 |
| E0951 |
Loop heel |
45 |
27 |
$733.24 |
| E0260 |
Hosp bed semi-electr w/ matt |
15 |
14 |
$682.05 |
| E0570 |
Nebulizer with compression |
39 |
39 |
$645.17 |
| E2210 |
Wheelchair bearings |
45 |
25 |
$259.75 |