| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
294 |
250 |
$115K |
| E1028 |
W/c manual swingaway |
2,398 |
1,250 |
$87K |
| K0108 |
W/c component-accessory nos |
385 |
160 |
$85K |
| E0955 |
Cushioned headrest |
634 |
535 |
$26K |
| K0739 |
Repair/svc dme non-oxygen eq |
608 |
520 |
$21K |
| E0973 |
W/ch access det adj armrest |
264 |
122 |
$11K |
| E2203 |
Frame depth less than 22 in |
22 |
13 |
$5K |
| E2615 |
Pos back post/lat wdth <22in |
18 |
13 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
18 |
16 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
110 |
48 |
$2K |
| K0040 |
Adjustable angle footplate |
40 |
12 |
$1K |
| E0951 |
Loop heel |
66 |
27 |
$526.34 |
| E0961 |
Wheelchair brake extension |
28 |
13 |
$462.07 |
| E0978 |
W/c acc,saf belt pelv strap |
21 |
18 |
$357.26 |