| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
14,072 |
8,876 |
$3.22M |
| E2617 |
Custom fab w/c back cushion |
2,218 |
1,606 |
$2.40M |
| E1399 |
Durable medical equipment mi |
1,825 |
1,277 |
$2.19M |
| K0005 |
Ultralightweight wheelchair |
1,685 |
1,269 |
$2.19M |
| E1161 |
Manual adult wc w tiltinspac |
4,585 |
3,887 |
$2.14M |
| E1007 |
Pwr seat combo w/shear |
303 |
205 |
$1.64M |
| E1028 |
W/c manual swingaway |
10,008 |
7,465 |
$1.63M |
| E2609 |
Custom fabricate w/c cushion |
1,490 |
1,097 |
$1.45M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
443 |
321 |
$1.43M |
| A4353 |
Intermittent urinary cath |
1,037 |
948 |
$958K |
| E0973 |
W/ch access det adj armrest |
5,475 |
3,863 |
$847K |
| K0739 |
Repair/svc dme non-oxygen eq |
13,404 |
10,129 |
$803K |
| E0955 |
Cushioned headrest |
7,628 |
5,989 |
$711K |
| E2311 |
Electro connect btw 2 sys |
442 |
326 |
$621K |
| E1012 |
Ctr mount pwr elev leg rest |
327 |
253 |
$576K |
| E2607 |
Skin pro/pos wc cus wd <22in |
2,509 |
1,789 |
$529K |
| K0040 |
Adjustable angle footplate |
4,975 |
3,542 |
$514K |
| E0956 |
W/c lateral trunk/hip suppor |
3,209 |
2,143 |
$495K |
| E2620 |
Wc planar back cush wd <22in |
1,250 |
901 |
$463K |
| E0960 |
W/c shoulder harness/straps |
4,599 |
3,217 |
$343K |
| E0971 |
Wheelchair anti-tipping devi |
4,317 |
3,071 |
$291K |
| K0823 |
Pwc gp 2 std cap chair |
538 |
510 |
$223K |
| E2613 |
Position back cush wd <22in |
701 |
506 |
$221K |
| E0978 |
W/c acc,saf belt pelv strap |
5,558 |
3,940 |
$179K |
| E2213 |
Pneumatic prop tire insert |
3,665 |
2,605 |
$164K |
| E0950 |
Tray |
1,906 |
1,371 |
$161K |
| E2231 |
Solid seat support base |
1,254 |
881 |
$156K |
| E2374 |
Hand/chin ctrl std joystick |
514 |
413 |
$149K |
| E2211 |
Pneumatic propulsion tire |
2,765 |
1,946 |
$145K |
| E2624 |
Adj skin pro/pos cus<22in |
563 |
409 |
$128K |
| E2377 |
Expandable controller, initl |
363 |
244 |
$116K |
| E2361 |
22nf sealed leadacid battery |
596 |
438 |
$107K |
| E0953 |
W/c lateral thigh/knee sup |
1,067 |
680 |
$105K |
| E2615 |
Pos back post/lat wdth <22in |
333 |
249 |
$105K |
| E0951 |
Loop heel |
3,422 |
2,506 |
$98K |
| T4541 |
Large disposable underpad |
1,691 |
1,538 |
$92K |
| E2313 |
Pwc harness, expand control |
371 |
257 |
$89K |
| E1236 |
Folding ped wc adjustable |
68 |
53 |
$88K |
| K0070 |
Rr whl compl pne tire rep ea |
341 |
221 |
$81K |
| E0961 |
Wheelchair brake extension |
1,848 |
1,322 |
$80K |
| E2392 |
Solid caster tire, integrate |
957 |
689 |
$79K |
| E2206 |
Man wc whl lock comp repl ea |
1,412 |
966 |
$73K |
| E1002 |
Pwr seat tilt |
28 |
25 |
$70K |
| E2366 |
Battery charger, single mode |
461 |
360 |
$63K |
| E2622 |
Adj skin pro w/c cus wd<22in |
268 |
210 |
$60K |
| E2363 |
Gr24 sealed leadacid battery |
259 |
199 |
$57K |
| E2386 |
Foam filled drive wheel tire |
279 |
201 |
$53K |
| K0856 |
Pwc gp3 std sing pow opt s/b |
15 |
12 |
$52K |
| E0952 |
Toe loop/holder, each |
1,570 |
1,134 |
$42K |
| E2359 |
Gr34 sealed leadacid battery |
151 |
122 |
$42K |
| E0630 |
Patient lift hydraulic |
423 |
392 |
$39K |
| K0077 |
Fr cstr asmb sol tire rep ea |
401 |
289 |
$34K |
| K0019 |
Arm pad repl, each |
1,866 |
1,370 |
$34K |
| E2394 |
Drive wheel excludes tire |
242 |
173 |
$23K |
| A4927 |
Non-sterile gloves |
1,354 |
1,231 |
$18K |
| E2205 |
Manual wc accessory, handrim |
335 |
223 |
$15K |
| K0038 |
Leg strap each |
675 |
505 |
$14K |
| E2203 |
Frame depth less than 22 in |
24 |
14 |
$7K |
| T4523 |
Adult size brief/diaper lg |
66 |
63 |
$4K |
| K0072 |
Fr cstr semi-pne tire rep ea |
36 |
26 |
$3K |
| K0018 |
Detach adjust armrst upper |
43 |
30 |
$1K |
| T4535 |
Disposable liner/shield/pad |
38 |
37 |
$1K |
| E2619 |
Replace cover w/c seat cush |
32 |
24 |
$1K |
| K0043 |
Ftrst lowr exten tube rep ea |
54 |
27 |
$991.57 |
| E0954 |
Foot box, any type each foot |
15 |
12 |
$913.38 |
| E0981 |
Seat upholstery, replacement |
18 |
13 |
$723.07 |
| A4402 |
Lubricant per ounce |
98 |
90 |
$604.77 |
| K0017 |
Detach adjust armrest base |
14 |
12 |
$566.22 |