| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
13,551 |
3,217 |
$658K |
| E1161 |
Manual adult wc w tiltinspac |
3,053 |
2,285 |
$569K |
| E1399 |
Durable medical equipment mi |
1,554 |
222 |
$501K |
| E1028 |
W/c manual swingaway |
9,321 |
4,000 |
$380K |
| K0739 |
Repair/svc dme non-oxygen eq |
7,521 |
4,785 |
$241K |
| E0955 |
Cushioned headrest |
4,642 |
3,191 |
$150K |
| E0973 |
W/ch access det adj armrest |
2,488 |
1,209 |
$106K |
| K0040 |
Adjustable angle footplate |
1,497 |
745 |
$68K |
| K0823 |
Pwc gp 2 std cap chair |
1,403 |
1,105 |
$68K |
| E0956 |
W/c lateral trunk/hip suppor |
690 |
254 |
$45K |
| E0240 |
Bath/shower chair |
37 |
13 |
$44K |
| E0971 |
Wheelchair anti-tipping devi |
970 |
535 |
$32K |
| E0960 |
W/c shoulder harness/straps |
689 |
385 |
$30K |
| E0978 |
W/c acc,saf belt pelv strap |
1,731 |
1,006 |
$24K |
| E2311 |
Electro connect btw 2 sys |
44 |
24 |
$18K |
| E2366 |
Battery charger, single mode |
269 |
194 |
$15K |
| E2392 |
Solid caster tire, integrate |
428 |
207 |
$14K |
| E2374 |
Hand/chin ctrl std joystick |
149 |
87 |
$12K |
| E2361 |
22nf sealed leadacid battery |
239 |
119 |
$11K |
| E2213 |
Pneumatic prop tire insert |
354 |
183 |
$6K |
| E2359 |
Gr34 sealed leadacid battery |
41 |
28 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
41 |
24 |
$5K |
| E0951 |
Loop heel |
411 |
216 |
$5K |
| E2622 |
Adj skin pro w/c cus wd<22in |
37 |
25 |
$5K |
| E2394 |
Drive wheel excludes tire |
127 |
68 |
$4K |
| E1012 |
Ctr mount pwr elev leg rest |
19 |
13 |
$4K |
| K0019 |
Arm pad repl, each |
374 |
193 |
$2K |
| E0950 |
Tray |
45 |
24 |
$2K |
| E2386 |
Foam filled drive wheel tire |
41 |
27 |
$2K |
| E0952 |
Toe loop/holder, each |
26 |
14 |
$492.36 |