| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,675 |
1,604 |
$1.03M |
| E1399 |
Durable medical equipment mi |
625 |
446 |
$707K |
| E1028 |
W/c manual swingaway |
489 |
336 |
$81K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,653 |
2,185 |
$78K |
| E2294 |
Contour seat for ped size wc |
124 |
116 |
$44K |
| E0955 |
Cushioned headrest |
170 |
149 |
$21K |
| E0978 |
W/c acc,saf belt pelv strap |
367 |
330 |
$14K |
| E0950 |
Tray |
60 |
51 |
$9K |
| E2293 |
Contour back for ped size wc |
13 |
12 |
$7K |
| E0956 |
W/c lateral trunk/hip suppor |
51 |
41 |
$6K |
| E0973 |
W/ch access det adj armrest |
98 |
84 |
$5K |
| E0960 |
W/c shoulder harness/straps |
53 |
50 |
$4K |
| K0040 |
Adjustable angle footplate |
51 |
40 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
39 |
34 |
$2K |
| E2213 |
Pneumatic prop tire insert |
14 |
14 |
$547.38 |