| Code | Description | Claims | Beneficiaries | Total Paid |
| S5165 |
Home modifications; per service |
12 |
12 |
$120K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
268 |
177 |
$37K |
| K0004 |
High strength, lightweight wheelchair |
246 |
171 |
$13K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
242 |
167 |
$6K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
35 |
13 |
$2K |