| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
184 |
165 |
$1.14M |
| K0108 |
W/c component-accessory nos |
1,051 |
830 |
$245K |
| E1161 |
Manual adult wc w tiltinspac |
570 |
550 |
$176K |
| E1028 |
W/c manual swingaway |
1,485 |
1,271 |
$168K |
| E1007 |
Pwr seat combo w/shear |
26 |
26 |
$123K |
| E0955 |
Cushioned headrest |
958 |
925 |
$50K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
12 |
12 |
$44K |
| E0973 |
W/ch access det adj armrest |
2,079 |
1,406 |
$43K |
| K0040 |
Adjustable angle footplate |
1,118 |
763 |
$36K |
| E2311 |
Electro connect btw 2 sys |
28 |
28 |
$34K |
| T4541 |
Large disposable underpad |
1,255 |
1,239 |
$30K |
| T4535 |
Disposable liner/shield/pad |
543 |
540 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
1,013 |
671 |
$20K |
| A4927 |
Non-sterile gloves |
916 |
890 |
$19K |
| T4528 |
Adult size pull-on xl |
134 |
134 |
$14K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,181 |
1,105 |
$12K |
| E0260 |
Hosp bed semi-electr w/ matt |
208 |
204 |
$10K |
| E1012 |
Ctr mount pwr elev leg rest |
15 |
15 |
$10K |
| E0956 |
W/c lateral trunk/hip suppor |
193 |
135 |
$10K |
| E2377 |
Expandable controller, initl |
39 |
39 |
$9K |
| E2361 |
22nf sealed leadacid battery |
67 |
56 |
$8K |
| E2620 |
Wc planar back cush wd <22in |
16 |
16 |
$6K |
| E2213 |
Pneumatic prop tire insert |
435 |
267 |
$5K |
| T4527 |
Adult size pull-on lg |
40 |
40 |
$5K |
| E2313 |
Pwc harness, expand control |
27 |
27 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
321 |
309 |
$4K |
| E2231 |
Solid seat support base |
126 |
117 |
$4K |
| T4537 |
Reusable underpad bed size |
145 |
142 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
15 |
15 |
$2K |
| E2211 |
Pneumatic propulsion tire |
145 |
87 |
$2K |
| E0951 |
Loop heel |
229 |
154 |
$2K |
| T4526 |
Adult size pull-on med |
14 |
14 |
$1K |
| L2270 |
Varus/valgus strap padded/li |
21 |
12 |
$343.20 |
| K0001 |
Standard wheelchair |
24 |
24 |
$249.13 |