| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,957 |
1,036 |
$2.17M |
| K0108 |
W/c component-accessory nos |
7,466 |
2,142 |
$1.41M |
| E2609 |
Custom fabricate w/c cushion |
249 |
232 |
$427K |
| E2617 |
Custom fab w/c back cushion |
234 |
211 |
$372K |
| E1161 |
Manual adult wc w tiltinspac |
1,403 |
1,381 |
$328K |
| E1028 |
W/c manual swingaway |
5,081 |
3,493 |
$267K |
| E1007 |
Pwr seat combo w/shear |
74 |
63 |
$265K |
| K0005 |
Ultralightweight wheelchair |
203 |
198 |
$241K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
62 |
51 |
$199K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,170 |
2,800 |
$187K |
| E0240 |
Bath/shower chair |
117 |
109 |
$155K |
| E0955 |
Cushioned headrest |
2,817 |
2,669 |
$142K |
| E0973 |
W/ch access det adj armrest |
1,538 |
1,217 |
$102K |
| E2311 |
Electro connect btw 2 sys |
84 |
73 |
$81K |
| E2607 |
Skin pro/pos wc cus wd <22in |
407 |
376 |
$77K |
| K0040 |
Adjustable angle footplate |
1,212 |
1,011 |
$74K |
| K0823 |
Pwc gp 2 std cap chair |
495 |
492 |
$66K |
| E0956 |
W/c lateral trunk/hip suppor |
475 |
347 |
$53K |
| E0960 |
W/c shoulder harness/straps |
839 |
786 |
$49K |
| E0971 |
Wheelchair anti-tipping devi |
1,164 |
970 |
$45K |
| E2613 |
Position back cush wd <22in |
111 |
104 |
$30K |
| E1012 |
Ctr mount pwr elev leg rest |
68 |
57 |
$28K |
| E0950 |
Tray |
323 |
302 |
$28K |
| E0978 |
W/c acc,saf belt pelv strap |
1,299 |
1,226 |
$23K |
| E2377 |
Expandable controller, initl |
80 |
69 |
$18K |
| 97542 |
|
1,253 |
975 |
$17K |
| E2213 |
Pneumatic prop tire insert |
332 |
293 |
$12K |
| E2620 |
Wc planar back cush wd <22in |
34 |
29 |
$11K |
| E2313 |
Pwc harness, expand control |
70 |
58 |
$10K |
| E0961 |
Wheelchair brake extension |
302 |
248 |
$7K |
| E2361 |
22nf sealed leadacid battery |
50 |
43 |
$6K |
| K0038 |
Leg strap each |
233 |
224 |
$4K |
| E0951 |
Loop heel |
165 |
132 |
$2K |
| E2231 |
Solid seat support base |
13 |
13 |
$1K |