| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
10,174 |
6,203 |
$1.73M |
| E1399 |
Durable medical equipment mi |
2,213 |
835 |
$1.63M |
| K0739 |
Repair/svc dme non-oxygen eq |
12,397 |
11,078 |
$940K |
| E1161 |
Manual adult wc w tiltinspac |
4,187 |
4,089 |
$824K |
| E1028 |
W/c manual swingaway |
12,329 |
8,346 |
$629K |
| E0240 |
Bath/shower chair |
207 |
202 |
$383K |
| K0005 |
Ultralightweight wheelchair |
332 |
318 |
$366K |
| E1007 |
Pwr seat combo w/shear |
71 |
65 |
$218K |
| E0955 |
Cushioned headrest |
6,378 |
6,116 |
$206K |
| E0973 |
W/ch access det adj armrest |
2,463 |
2,104 |
$203K |
| K0823 |
Pwc gp 2 std cap chair |
873 |
833 |
$178K |
| E0956 |
W/c lateral trunk/hip suppor |
1,725 |
1,325 |
$167K |
| K0040 |
Adjustable angle footplate |
1,976 |
1,693 |
$119K |
| E2607 |
Skin pro/pos wc cus wd <22in |
815 |
763 |
$118K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
44 |
39 |
$108K |
| E0971 |
Wheelchair anti-tipping devi |
1,891 |
1,708 |
$84K |
| E0960 |
W/c shoulder harness/straps |
1,592 |
1,439 |
$83K |
| E2311 |
Electro connect btw 2 sys |
89 |
81 |
$78K |
| E2622 |
Adj skin pro w/c cus wd<22in |
420 |
398 |
$71K |
| E2361 |
22nf sealed leadacid battery |
530 |
504 |
$67K |
| E2617 |
Custom fab w/c back cushion |
137 |
126 |
$66K |
| E2213 |
Pneumatic prop tire insert |
1,856 |
1,695 |
$61K |
| E2211 |
Pneumatic propulsion tire |
1,453 |
1,315 |
$58K |
| E0978 |
W/c acc,saf belt pelv strap |
2,622 |
2,477 |
$52K |
| E1012 |
Ctr mount pwr elev leg rest |
102 |
93 |
$37K |
| E2374 |
Hand/chin ctrl std joystick |
149 |
137 |
$37K |
| E2620 |
Wc planar back cush wd <22in |
198 |
182 |
$36K |
| E0951 |
Loop heel |
1,757 |
1,541 |
$28K |
| E2231 |
Solid seat support base |
281 |
267 |
$24K |
| E0950 |
Tray |
383 |
359 |
$24K |
| E2392 |
Solid caster tire, integrate |
306 |
275 |
$17K |
| K0070 |
Rr whl compl pne tire rep ea |
87 |
81 |
$17K |
| E2613 |
Position back cush wd <22in |
67 |
63 |
$17K |
| K0019 |
Arm pad repl, each |
1,052 |
923 |
$12K |
| E0961 |
Wheelchair brake extension |
429 |
390 |
$11K |
| E2377 |
Expandable controller, initl |
59 |
51 |
$10K |
| E2386 |
Foam filled drive wheel tire |
72 |
66 |
$10K |
| E2394 |
Drive wheel excludes tire |
121 |
110 |
$8K |
| E2366 |
Battery charger, single mode |
82 |
78 |
$7K |
| E2313 |
Pwc harness, expand control |
47 |
40 |
$6K |
| E2206 |
Man wc whl lock comp repl ea |
151 |
123 |
$6K |
| E2363 |
Gr24 sealed leadacid battery |
44 |
37 |
$5K |
| E2624 |
Adj skin pro/pos cus<22in |
26 |
26 |
$4K |
| E2359 |
Gr34 sealed leadacid battery |
26 |
25 |
$4K |
| K0821 |
Pwc gp 2 std port cap chair |
12 |
12 |
$3K |
| E0952 |
Toe loop/holder, each |
137 |
129 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
13 |
13 |
$2K |
| E2205 |
Manual wc accessory, handrim |
40 |
38 |
$2K |
| K0195 |
Elevating whlchair leg rests |
393 |
385 |
$1K |
| K0077 |
Fr cstr asmb sol tire rep ea |
14 |
14 |
$1K |
| E0953 |
W/c lateral thigh/knee sup |
24 |
12 |
$599.00 |
| E2619 |
Replace cover w/c seat cush |
17 |
15 |
$361.96 |
| K0038 |
Leg strap each |
12 |
12 |
$248.56 |
| K0043 |
Ftrst lowr exten tube rep ea |
12 |
12 |
$201.22 |