| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
4,315 |
969 |
$1.59M |
| K0108 |
W/c component-accessory nos |
4,576 |
1,641 |
$632K |
| E1028 |
W/c manual swingaway |
3,300 |
2,679 |
$239K |
| E1161 |
Manual adult wc w tiltinspac |
553 |
553 |
$125K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,178 |
2,143 |
$109K |
| E0240 |
Bath/shower chair |
100 |
100 |
$106K |
| E0955 |
Cushioned headrest |
1,292 |
1,292 |
$81K |
| K0823 |
Pwc gp 2 std cap chair |
914 |
914 |
$75K |
| E0973 |
W/ch access det adj armrest |
933 |
752 |
$68K |
| E0956 |
W/c lateral trunk/hip suppor |
423 |
391 |
$56K |
| E1007 |
Pwr seat combo w/shear |
24 |
24 |
$52K |
| K0040 |
Adjustable angle footplate |
654 |
569 |
$41K |
| K0005 |
Ultralightweight wheelchair |
46 |
46 |
$33K |
| E2311 |
Electro connect btw 2 sys |
38 |
38 |
$30K |
| E2607 |
Skin pro/pos wc cus wd <22in |
170 |
170 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
657 |
551 |
$24K |
| E2613 |
Position back cush wd <22in |
93 |
93 |
$22K |
| K0825 |
Pwc gp 2 hd cap chair |
160 |
160 |
$21K |
| E1012 |
Ctr mount pwr elev leg rest |
25 |
25 |
$18K |
| E0950 |
Tray |
248 |
248 |
$18K |
| E0978 |
W/c acc,saf belt pelv strap |
689 |
689 |
$17K |
| E0635 |
Patient lift electric |
163 |
163 |
$16K |
| E0960 |
W/c shoulder harness/straps |
173 |
173 |
$11K |
| A9901 |
Delivery/set up/dispensing |
120 |
118 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
371 |
371 |
$10K |
| E2620 |
Wc planar back cush wd <22in |
37 |
37 |
$8K |
| E2622 |
Adj skin pro w/c cus wd<22in |
40 |
40 |
$7K |
| E2377 |
Expandable controller, initl |
38 |
38 |
$7K |
| E0630 |
Patient lift hydraulic |
130 |
130 |
$6K |
| E2313 |
Pwc harness, expand control |
49 |
49 |
$5K |
| E2211 |
Pneumatic propulsion tire |
196 |
145 |
$5K |
| E2213 |
Pneumatic prop tire insert |
177 |
133 |
$3K |
| E2615 |
Pos back post/lat wdth <22in |
12 |
12 |
$3K |
| K0003 |
Lightweight wheelchair |
52 |
52 |
$2K |
| E2361 |
22nf sealed leadacid battery |
24 |
24 |
$2K |
| E2359 |
Gr34 sealed leadacid battery |
12 |
12 |
$1K |
| E2365 |
U1 sealed leadacid battery |
13 |
13 |
$688.59 |
| E0961 |
Wheelchair brake extension |
19 |
15 |
$464.94 |
| K0019 |
Arm pad repl, each |
39 |
38 |
$410.95 |
| E0951 |
Loop heel |
13 |
13 |
$242.52 |
| K0038 |
Leg strap each |
12 |
12 |
$188.47 |