| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
10,160 |
4,933 |
$1.46M |
| E1399 |
Durable medical equipment mi |
1,331 |
517 |
$1.19M |
| E1028 |
W/c manual swingaway |
14,065 |
8,718 |
$974K |
| E1161 |
Manual adult wc w tiltinspac |
2,704 |
2,538 |
$854K |
| K0005 |
Ultralightweight wheelchair |
620 |
545 |
$687K |
| K0823 |
Pwc gp 2 std cap chair |
2,893 |
2,601 |
$386K |
| E0973 |
W/ch access det adj armrest |
4,015 |
3,145 |
$332K |
| K0739 |
Repair/svc dme non-oxygen eq |
10,377 |
8,753 |
$295K |
| E0955 |
Cushioned headrest |
4,715 |
4,176 |
$257K |
| E0956 |
W/c lateral trunk/hip suppor |
2,450 |
1,363 |
$201K |
| K0040 |
Adjustable angle footplate |
2,628 |
2,165 |
$193K |
| E2617 |
Custom fab w/c back cushion |
165 |
137 |
$152K |
| E2361 |
22nf sealed leadacid battery |
1,396 |
1,174 |
$144K |
| E1012 |
Ctr mount pwr elev leg rest |
168 |
124 |
$140K |
| E0971 |
Wheelchair anti-tipping devi |
2,790 |
2,334 |
$128K |
| E2607 |
Skin pro/pos wc cus wd <22in |
837 |
706 |
$125K |
| Z0160 |
|
1,117 |
696 |
$96K |
| E2624 |
Adj skin pro/pos cus<22in |
508 |
422 |
$90K |
| E0960 |
W/c shoulder harness/straps |
1,612 |
1,357 |
$89K |
| E1002 |
Pwr seat tilt |
34 |
28 |
$84K |
| E0978 |
W/c acc,saf belt pelv strap |
3,102 |
2,673 |
$64K |
| E2213 |
Pneumatic prop tire insert |
2,092 |
1,730 |
$63K |
| E2374 |
Hand/chin ctrl std joystick |
298 |
239 |
$57K |
| K0825 |
Pwc gp 2 hd cap chair |
320 |
286 |
$57K |
| E2392 |
Solid caster tire, integrate |
890 |
693 |
$54K |
| E2620 |
Wc planar back cush wd <22in |
227 |
186 |
$52K |
| E2211 |
Pneumatic propulsion tire |
1,413 |
1,183 |
$50K |
| E2311 |
Electro connect btw 2 sys |
62 |
48 |
$50K |
| E0950 |
Tray |
860 |
716 |
$50K |
| E2366 |
Battery charger, single mode |
422 |
367 |
$42K |
| E2609 |
Custom fabricate w/c cushion |
68 |
53 |
$42K |
| E2611 |
Gen use back cush wdth <22in |
294 |
250 |
$39K |
| E2365 |
U1 sealed leadacid battery |
428 |
369 |
$32K |
| K0004 |
High strength ltwt whlchr |
585 |
499 |
$29K |
| E2386 |
Foam filled drive wheel tire |
265 |
209 |
$26K |
| E2622 |
Adj skin pro w/c cus wd<22in |
149 |
124 |
$23K |
| E0951 |
Loop heel |
1,376 |
1,089 |
$22K |
| E2231 |
Solid seat support base |
176 |
153 |
$17K |
| E0630 |
Patient lift hydraulic |
142 |
105 |
$15K |
| K0821 |
Pwc gp 2 std port cap chair |
133 |
130 |
$15K |
| E8000 |
Posterior gait trainer |
12 |
12 |
$14K |
| K0003 |
Lightweight wheelchair |
526 |
411 |
$13K |
| E0961 |
Wheelchair brake extension |
531 |
436 |
$13K |
| E2394 |
Drive wheel excludes tire |
260 |
200 |
$13K |
| E2206 |
Man wc whl lock comp repl ea |
271 |
220 |
$11K |
| K0019 |
Arm pad repl, each |
841 |
668 |
$10K |
| E0953 |
W/c lateral thigh/knee sup |
177 |
120 |
$9K |
| E2363 |
Gr24 sealed leadacid battery |
33 |
29 |
$4K |
| K0038 |
Leg strap each |
281 |
234 |
$4K |
| E2219 |
Foam caster tire any size ea |
53 |
43 |
$3K |
| E2313 |
Pwc harness, expand control |
18 |
12 |
$2K |
| E2359 |
Gr34 sealed leadacid battery |
12 |
12 |
$2K |
| K0077 |
Fr cstr asmb sol tire rep ea |
13 |
13 |
$635.77 |
| E2601 |
Gen w/c cushion wdth < 22 in |
19 |
13 |
$396.80 |
| E0952 |
Toe loop/holder, each |
14 |
13 |
$296.09 |
| K0043 |
Ftrst lowr exten tube rep ea |
16 |
12 |
$249.52 |
| K0195 |
Elevating whlchair leg rests |
16 |
13 |
$51.08 |