| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
7,017 |
4,575 |
$1.73M |
| E1028 |
W/c manual swingaway |
10,251 |
7,716 |
$1.12M |
| E1161 |
Manual adult wc w tiltinspac |
3,942 |
3,634 |
$1.11M |
| T2029 |
Special med equip, noswaiver |
2,538 |
2,312 |
$982K |
| E1399 |
Durable medical equipment mi |
876 |
359 |
$648K |
| E2617 |
Custom fab w/c back cushion |
359 |
276 |
$394K |
| E0973 |
W/ch access det adj armrest |
3,198 |
2,574 |
$365K |
| E0955 |
Cushioned headrest |
5,842 |
5,152 |
$352K |
| K0739 |
Repair/svc dme non-oxygen eq |
11,416 |
9,547 |
$319K |
| K0040 |
Adjustable angle footplate |
2,536 |
2,000 |
$239K |
| E0956 |
W/c lateral trunk/hip suppor |
1,679 |
1,208 |
$224K |
| K0823 |
Pwc gp 2 std cap chair |
1,239 |
1,131 |
$220K |
| K0005 |
Ultralightweight wheelchair |
165 |
131 |
$204K |
| Z0160 |
|
2,548 |
1,616 |
$202K |
| E1007 |
Pwr seat combo w/shear |
36 |
26 |
$165K |
| K0004 |
High strength ltwt whlchr |
2,322 |
1,721 |
$159K |
| E2607 |
Skin pro/pos wc cus wd <22in |
749 |
635 |
$141K |
| E2609 |
Custom fabricate w/c cushion |
111 |
95 |
$129K |
| E0971 |
Wheelchair anti-tipping devi |
2,390 |
1,921 |
$128K |
| E0960 |
W/c shoulder harness/straps |
1,859 |
1,500 |
$121K |
| E2613 |
Position back cush wd <22in |
391 |
324 |
$113K |
| E2361 |
22nf sealed leadacid battery |
717 |
599 |
$104K |
| A4351 |
Straight tip urine catheter |
706 |
557 |
$101K |
| E1012 |
Ctr mount pwr elev leg rest |
59 |
39 |
$84K |
| E0978 |
W/c acc,saf belt pelv strap |
3,096 |
2,503 |
$83K |
| E2311 |
Electro connect btw 2 sys |
67 |
50 |
$80K |
| E0950 |
Tray |
880 |
701 |
$63K |
| E2213 |
Pneumatic prop tire insert |
1,480 |
1,221 |
$56K |
| E2624 |
Adj skin pro/pos cus<22in |
278 |
219 |
$55K |
| E2392 |
Solid caster tire, integrate |
603 |
450 |
$48K |
| E2231 |
Solid seat support base |
382 |
327 |
$47K |
| E2374 |
Hand/chin ctrl std joystick |
178 |
142 |
$47K |
| E2211 |
Pneumatic propulsion tire |
994 |
830 |
$45K |
| E2386 |
Foam filled drive wheel tire |
255 |
191 |
$42K |
| E2622 |
Adj skin pro w/c cus wd<22in |
191 |
138 |
$36K |
| E0260 |
Hosp bed semi-electr w/ matt |
560 |
383 |
$33K |
| E0630 |
Patient lift hydraulic |
605 |
418 |
$33K |
| E0951 |
Loop heel |
1,341 |
1,093 |
$29K |
| E2620 |
Wc planar back cush wd <22in |
88 |
74 |
$25K |
| E0953 |
W/c lateral thigh/knee sup |
203 |
155 |
$17K |
| E2394 |
Drive wheel excludes tire |
204 |
153 |
$16K |
| K0019 |
Arm pad repl, each |
700 |
530 |
$11K |
| E2313 |
Pwc harness, expand control |
30 |
25 |
$8K |
| E2366 |
Battery charger, single mode |
61 |
53 |
$7K |
| E0961 |
Wheelchair brake extension |
218 |
177 |
$7K |
| E2377 |
Expandable controller, initl |
15 |
13 |
$5K |
| E2359 |
Gr34 sealed leadacid battery |
16 |
14 |
$4K |
| K0070 |
Rr whl compl pne tire rep ea |
19 |
12 |
$4K |
| K0825 |
Pwc gp 2 hd cap chair |
51 |
50 |
$4K |
| E2206 |
Man wc whl lock comp repl ea |
72 |
45 |
$3K |
| E0952 |
Toe loop/holder, each |
118 |
87 |
$2K |
| E2363 |
Gr24 sealed leadacid battery |
15 |
13 |
$2K |
| E2219 |
Foam caster tire any size ea |
21 |
14 |
$1K |
| E0954 |
Foot box, any type each foot |
17 |
13 |
$1K |
| K0017 |
Detach adjust armrest base |
20 |
12 |
$926.89 |
| K0195 |
Elevating whlchair leg rests |
342 |
336 |
$917.14 |
| K0038 |
Leg strap each |
18 |
12 |
$385.29 |