| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
4,699 |
4,689 |
$932K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,255 |
942 |
$334K |
| E1399 |
Durable medical equipment, miscellaneous |
111 |
97 |
$216K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,157 |
5,117 |
$140K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
2,279 |
2,248 |
$110K |
| K0040 |
Adjustable angle footplate, each |
1,563 |
1,379 |
$98K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
5,984 |
4,776 |
$95K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
52 |
52 |
$62K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,016 |
1,008 |
$50K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
51 |
51 |
$48K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
326 |
289 |
$48K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,315 |
999 |
$40K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,157 |
1,137 |
$39K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
195 |
190 |
$28K |
| A4554 |
Disposable underpads, all sizes |
238 |
235 |
$17K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
90 |
90 |
$12K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
436 |
432 |
$9K |
| E0950 |
Wheelchair accessory, tray, each |
91 |
91 |
$9K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
345 |
229 |
$8K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
589 |
436 |
$7K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
39 |
38 |
$7K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
58 |
57 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
259 |
259 |
$2K |
| E0570 |
Nebulizer, with compressor |
65 |
65 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
13 |
12 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14 |
14 |
$1K |
| K0001 |
Standard wheelchair |
25 |
25 |
$803.79 |
| K0019 |
Arm pad, replacement only, each |
27 |
26 |
$479.16 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$54.60 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
75 |
74 |
$28.37 |