| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,746 |
1,243 |
$2.80M |
| K0108 |
W/c component-accessory nos |
7,919 |
3,819 |
$1.26M |
| E1161 |
Manual adult wc w tiltinspac |
5,082 |
5,037 |
$717K |
| E2617 |
Custom fab w/c back cushion |
510 |
498 |
$473K |
| E1028 |
W/c manual swingaway |
9,502 |
7,811 |
$405K |
| E2609 |
Custom fabricate w/c cushion |
384 |
376 |
$322K |
| K0005 |
Ultralightweight wheelchair |
339 |
334 |
$279K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,524 |
5,271 |
$259K |
| E0955 |
Cushioned headrest |
6,486 |
6,405 |
$215K |
| E0973 |
W/ch access det adj armrest |
2,554 |
2,100 |
$144K |
| E0956 |
W/c lateral trunk/hip suppor |
1,001 |
797 |
$122K |
| K0040 |
Adjustable angle footplate |
2,409 |
2,008 |
$112K |
| K0823 |
Pwc gp 2 std cap chair |
731 |
728 |
$111K |
| E2361 |
22nf sealed leadacid battery |
864 |
836 |
$95K |
| E2607 |
Skin pro/pos wc cus wd <22in |
633 |
620 |
$95K |
| E0971 |
Wheelchair anti-tipping devi |
2,342 |
1,961 |
$89K |
| E0960 |
W/c shoulder harness/straps |
1,537 |
1,498 |
$80K |
| E2620 |
Wc planar back cush wd <22in |
279 |
273 |
$47K |
| E0978 |
W/c acc,saf belt pelv strap |
2,290 |
2,245 |
$43K |
| E2211 |
Pneumatic propulsion tire |
1,230 |
1,019 |
$36K |
| E2213 |
Pneumatic prop tire insert |
1,301 |
1,090 |
$34K |
| E2311 |
Electro connect btw 2 sys |
38 |
37 |
$33K |
| E0240 |
Bath/shower chair |
25 |
25 |
$25K |
| E0951 |
Loop heel |
1,758 |
1,442 |
$24K |
| E1012 |
Ctr mount pwr elev leg rest |
39 |
38 |
$19K |
| E0635 |
Patient lift electric |
175 |
173 |
$18K |
| E2622 |
Adj skin pro w/c cus wd<22in |
88 |
87 |
$16K |
| E0950 |
Tray |
220 |
214 |
$14K |
| K0004 |
High strength ltwt whlchr |
362 |
362 |
$14K |
| E2613 |
Position back cush wd <22in |
55 |
55 |
$11K |
| E1236 |
Folding ped wc adjustable |
12 |
12 |
$7K |
| K0019 |
Arm pad repl, each |
565 |
438 |
$6K |
| E2624 |
Adj skin pro/pos cus<22in |
37 |
37 |
$5K |
| E2231 |
Solid seat support base |
95 |
92 |
$4K |
| E0952 |
Toe loop/holder, each |
226 |
198 |
$4K |
| E2377 |
Expandable controller, initl |
12 |
12 |
$3K |
| E0961 |
Wheelchair brake extension |
142 |
114 |
$3K |
| E2313 |
Pwc harness, expand control |
24 |
24 |
$2K |
| E2392 |
Solid caster tire, integrate |
34 |
25 |
$2K |
| E2615 |
Pos back post/lat wdth <22in |
12 |
12 |
$2K |
| K0038 |
Leg strap each |
108 |
105 |
$1K |
| E2374 |
Hand/chin ctrl std joystick |
16 |
15 |
$1K |
| E0953 |
W/c lateral thigh/knee sup |
17 |
12 |
$697.85 |
| K0195 |
Elevating whlchair leg rests |
306 |
306 |
$694.38 |
| E2206 |
Man wc whl lock comp repl ea |
18 |
13 |
$458.99 |
| E2601 |
Gen w/c cushion wdth < 22 in |
13 |
13 |
$236.46 |