| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,983 |
1,229 |
$591K |
| E1028 |
W/c manual swingaway |
1,938 |
1,122 |
$155K |
| E1399 |
Durable medical equipment mi |
152 |
68 |
$97K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,678 |
1,478 |
$80K |
| E0955 |
Cushioned headrest |
996 |
904 |
$66K |
| E1161 |
Manual adult wc w tiltinspac |
218 |
211 |
$37K |
| E2607 |
Skin pro/pos wc cus wd <22in |
48 |
43 |
$14K |
| E0973 |
W/ch access det adj armrest |
159 |
127 |
$13K |
| K0040 |
Adjustable angle footplate |
138 |
106 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
117 |
94 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
225 |
180 |
$5K |
| E0960 |
W/c shoulder harness/straps |
63 |
54 |
$4K |
| 97542 |
|
99 |
45 |
$3K |