| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,088 |
1,760 |
$443K |
| E1161 |
Manual adult wc w tiltinspac |
2,137 |
1,947 |
$272K |
| E1028 |
W/c manual swingaway |
5,195 |
3,408 |
$164K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,283 |
2,733 |
$64K |
| E0240 |
Bath/shower chair |
47 |
39 |
$57K |
| E0955 |
Cushioned headrest |
2,537 |
2,332 |
$53K |
| E1399 |
Durable medical equipment mi |
111 |
70 |
$40K |
| E0973 |
W/ch access det adj armrest |
555 |
371 |
$27K |
| K0004 |
High strength ltwt whlchr |
695 |
656 |
$19K |
| K0823 |
Pwc gp 2 std cap chair |
157 |
151 |
$12K |
| K0040 |
Adjustable angle footplate |
207 |
132 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
230 |
159 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
213 |
189 |
$4K |
| E0635 |
Patient lift electric |
14 |
12 |
$1K |
| E0956 |
W/c lateral trunk/hip suppor |
20 |
12 |
$1K |
| E0950 |
Tray |
16 |
15 |
$1K |
| E0960 |
W/c shoulder harness/straps |
29 |
27 |
$964.72 |
| E0951 |
Loop heel |
104 |
59 |
$863.60 |
| E2361 |
22nf sealed leadacid battery |
12 |
12 |
$434.53 |
| E2213 |
Pneumatic prop tire insert |
21 |
12 |
$258.40 |
| K0019 |
Arm pad repl, each |
22 |
13 |
$74.44 |