| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
13,697 |
12,639 |
$975K |
| K0825 |
Pwc gp 2 hd cap chair |
2,620 |
2,450 |
$234K |
| E2365 |
U1 sealed leadacid battery |
2,797 |
2,467 |
$117K |
| K0822 |
Pwc gp 2 std seat/back |
1,103 |
962 |
$58K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,533 |
1,319 |
$13K |
| K0195 |
Elevating whlchair leg rests |
5,651 |
5,207 |
$11K |
| K0108 |
W/c component-accessory nos |
60 |
44 |
$8K |
| E0973 |
W/ch access det adj armrest |
497 |
329 |
$7K |
| E2359 |
Gr34 sealed leadacid battery |
71 |
64 |
$5K |
| E2366 |
Battery charger, single mode |
54 |
38 |
$3K |
| E2375 |
Non-expandable controller |
20 |
14 |
$3K |
| E2381 |
Pneum drive wheel tire |
89 |
73 |
$2K |
| E1020 |
Residual limb support system |
436 |
267 |
$2K |
| E0955 |
Cushioned headrest |
191 |
161 |
$812.63 |
| E2391 |
Solid caster tire |
75 |
66 |
$770.03 |
| E2382 |
Tube, pneum wheel drive tire |
27 |
26 |
$388.41 |
| E2208 |
Cylinder tank carrier |
13 |
12 |
$264.44 |