| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
4,699 |
4,689 |
$932K |
| K0108 |
W/c component-accessory nos |
1,255 |
942 |
$334K |
| E1399 |
Durable medical equipment mi |
111 |
97 |
$216K |
| E0955 |
Cushioned headrest |
5,157 |
5,117 |
$140K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,279 |
2,248 |
$110K |
| K0040 |
Adjustable angle footplate |
1,563 |
1,379 |
$98K |
| E1028 |
W/c manual swingaway |
5,984 |
4,776 |
$95K |
| E2617 |
Custom fab w/c back cushion |
52 |
52 |
$62K |
| E0960 |
W/c shoulder harness/straps |
1,016 |
1,008 |
$50K |
| E2609 |
Custom fabricate w/c cushion |
51 |
51 |
$48K |
| E0956 |
W/c lateral trunk/hip suppor |
326 |
289 |
$48K |
| E0971 |
Wheelchair anti-tipping devi |
1,315 |
999 |
$40K |
| E2213 |
Pneumatic prop tire insert |
1,157 |
1,137 |
$39K |
| E2607 |
Skin pro/pos wc cus wd <22in |
195 |
190 |
$28K |
| A4554 |
Disposable underpads |
238 |
235 |
$17K |
| T4523 |
Adult size brief/diaper lg |
90 |
90 |
$12K |
| E2211 |
Pneumatic propulsion tire |
436 |
432 |
$9K |
| E0950 |
Tray |
91 |
91 |
$9K |
| E0973 |
W/ch access det adj armrest |
345 |
229 |
$8K |
| E0951 |
Loop heel |
589 |
436 |
$7K |
| E2620 |
Wc planar back cush wd <22in |
39 |
38 |
$7K |
| E2231 |
Solid seat support base |
58 |
57 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
259 |
259 |
$2K |
| E0570 |
Nebulizer with compression |
65 |
65 |
$2K |
| E0990 |
Wheelchair elevating leg res |
13 |
12 |
$2K |
| T4522 |
Adult size brief/diaper med |
14 |
14 |
$1K |
| K0001 |
Standard wheelchair |
25 |
25 |
$803.79 |
| K0019 |
Arm pad repl, each |
27 |
26 |
$479.16 |
| A4927 |
Non-sterile gloves |
12 |
12 |
$54.60 |
| K0195 |
Elevating whlchair leg rests |
75 |
74 |
$28.37 |