| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
2,506 |
2,501 |
$244K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,114 |
1,074 |
$57K |
| E0955 |
Cushioned headrest |
2,571 |
2,558 |
$39K |
| E1028 |
W/c manual swingaway |
2,608 |
2,142 |
$20K |
| K0108 |
W/c component-accessory nos |
122 |
82 |
$16K |
| K0040 |
Adjustable angle footplate |
96 |
62 |
$2K |
| E2607 |
Skin pro/pos wc cus wd <22in |
12 |
12 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
60 |
37 |
$699.41 |
| E2213 |
Pneumatic prop tire insert |
17 |
12 |
$392.19 |
| E2211 |
Pneumatic propulsion tire |
18 |
13 |
$131.47 |
| E0951 |
Loop heel |
23 |
12 |
$71.29 |
| E0978 |
W/c acc,saf belt pelv strap |
12 |
12 |
$67.68 |