| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,701 |
2,748 |
$5.54M |
| K0108 |
W/c component-accessory nos |
8,450 |
5,901 |
$2.28M |
| E1028 |
W/c manual swingaway |
5,561 |
4,407 |
$935K |
| E1007 |
Pwr seat combo w/shear |
155 |
142 |
$789K |
| K0739 |
Repair/svc dme non-oxygen eq |
10,395 |
8,815 |
$785K |
| K0005 |
Ultralightweight wheelchair |
405 |
376 |
$570K |
| E2311 |
Electro connect btw 2 sys |
414 |
368 |
$510K |
| E1161 |
Manual adult wc w tiltinspac |
1,081 |
1,019 |
$480K |
| E0973 |
W/ch access det adj armrest |
2,689 |
2,329 |
$400K |
| E0955 |
Cushioned headrest |
3,005 |
2,556 |
$296K |
| E1012 |
Ctr mount pwr elev leg rest |
435 |
388 |
$271K |
| A9900 |
Supply/accessory/service |
3,214 |
2,614 |
$215K |
| E2607 |
Skin pro/pos wc cus wd <22in |
903 |
817 |
$213K |
| E2363 |
Gr24 sealed leadacid battery |
751 |
646 |
$168K |
| E2620 |
Wc planar back cush wd <22in |
442 |
390 |
$165K |
| E0240 |
Bath/shower chair |
104 |
98 |
$156K |
| K0040 |
Adjustable angle footplate |
1,443 |
1,299 |
$156K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
39 |
37 |
$124K |
| E2300 |
Pwr seat elevation sys |
51 |
42 |
$116K |
| K0669 |
Seat/back cus no dmepdac ver |
12 |
12 |
$98K |
| E0960 |
W/c shoulder harness/straps |
1,227 |
1,122 |
$92K |
| K0823 |
Pwc gp 2 std cap chair |
990 |
954 |
$92K |
| E0978 |
W/c acc,saf belt pelv strap |
2,553 |
2,345 |
$82K |
| E0950 |
Tray |
533 |
474 |
$79K |
| E0971 |
Wheelchair anti-tipping devi |
1,786 |
1,641 |
$79K |
| E2386 |
Foam filled drive wheel tire |
642 |
553 |
$76K |
| E2392 |
Solid caster tire, integrate |
1,057 |
912 |
$73K |
| E0956 |
W/c lateral trunk/hip suppor |
544 |
428 |
$65K |
| E2361 |
22nf sealed leadacid battery |
514 |
402 |
$64K |
| E2394 |
Drive wheel excludes tire |
827 |
703 |
$49K |
| E1236 |
Folding ped wc adjustable |
26 |
26 |
$45K |
| E2377 |
Expandable controller, initl |
196 |
181 |
$44K |
| E2374 |
Hand/chin ctrl std joystick |
118 |
101 |
$38K |
| E2313 |
Pwc harness, expand control |
170 |
160 |
$27K |
| E2213 |
Pneumatic prop tire insert |
803 |
741 |
$26K |
| E2211 |
Pneumatic propulsion tire |
593 |
546 |
$25K |
| E2298 |
Pwr seat elev sys for crt |
18 |
13 |
$24K |
| E0951 |
Loop heel |
848 |
783 |
$17K |
| K0019 |
Arm pad repl, each |
1,120 |
955 |
$16K |
| T5001 |
Position seat spec orth need |
12 |
12 |
$15K |
| E2366 |
Battery charger, single mode |
105 |
76 |
$13K |
| E2611 |
Gen use back cush wdth <22in |
62 |
55 |
$12K |
| E2622 |
Adj skin pro w/c cus wd<22in |
56 |
52 |
$12K |
| E2613 |
Position back cush wd <22in |
30 |
27 |
$10K |
| K0038 |
Leg strap each |
353 |
335 |
$7K |
| E0961 |
Wheelchair brake extension |
187 |
169 |
$5K |
| K0070 |
Rr whl compl pne tire rep ea |
15 |
15 |
$4K |
| E2206 |
Man wc whl lock comp repl ea |
60 |
49 |
$3K |
| K0017 |
Detach adjust armrest base |
28 |
25 |
$1K |
| E2619 |
Replace cover w/c seat cush |
26 |
25 |
$730.30 |
| E2365 |
U1 sealed leadacid battery |
12 |
12 |
$629.47 |
| E2210 |
Wheelchair bearings |
29 |
27 |
$419.27 |