| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
184 |
165 |
$1.14M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,051 |
830 |
$245K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
570 |
550 |
$176K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,485 |
1,271 |
$168K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
26 |
26 |
$123K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
958 |
925 |
$50K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
12 |
12 |
$44K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
2,079 |
1,406 |
$43K |
| K0040 |
Adjustable angle footplate, each |
1,118 |
763 |
$36K |
| 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 |
28 |
28 |
$34K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,255 |
1,239 |
$30K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
543 |
540 |
$28K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,013 |
671 |
$20K |
| A4927 |
Gloves, non-sterile, per 100 |
916 |
890 |
$19K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
134 |
134 |
$14K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,181 |
1,105 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
208 |
204 |
$10K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
15 |
15 |
$10K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
193 |
135 |
$10K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
39 |
39 |
$9K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
67 |
56 |
$8K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
16 |
16 |
$6K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
435 |
267 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
40 |
40 |
$5K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
27 |
27 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
321 |
309 |
$4K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
126 |
117 |
$4K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
145 |
142 |
$3K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
15 |
15 |
$2K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
145 |
87 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
229 |
154 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
14 |
14 |
$1K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
21 |
12 |
$343.20 |
| K0001 |
Standard wheelchair |
24 |
24 |
$249.13 |