| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,441 |
1,401 |
$832K |
| E1161 |
Manual adult wc w tiltinspac |
1,156 |
1,086 |
$607K |
| E1028 |
W/c manual swingaway |
3,027 |
1,705 |
$223K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,074 |
1,447 |
$84K |
| E0955 |
Cushioned headrest |
979 |
830 |
$71K |
| E0973 |
W/ch access det adj armrest |
709 |
507 |
$59K |
| K0040 |
Adjustable angle footplate |
643 |
433 |
$41K |
| E2609 |
Custom fabricate w/c cushion |
17 |
14 |
$30K |
| E2311 |
Electro connect btw 2 sys |
19 |
15 |
$30K |
| E1012 |
Ctr mount pwr elev leg rest |
37 |
29 |
$29K |
| K0800 |
Pov group 1 std up to 300lbs |
51 |
46 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
523 |
402 |
$25K |
| E2361 |
22nf sealed leadacid battery |
153 |
127 |
$24K |
| E2231 |
Solid seat support base |
106 |
82 |
$11K |
| E2213 |
Pneumatic prop tire insert |
173 |
126 |
$7K |
| E2211 |
Pneumatic propulsion tire |
142 |
103 |
$6K |
| E2203 |
Frame depth less than 22 in |
16 |
13 |
$6K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
20 |
13 |
$3K |
| E0961 |
Wheelchair brake extension |
72 |
55 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
33 |
13 |
$2K |
| E0951 |
Loop heel |
96 |
67 |
$2K |
| E0954 |
Foot box, any type each foot |
15 |
12 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
14 |
$321.81 |