| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
97,584 |
87,024 |
$4.01M |
| K0825 |
Pwc gp 2 hd cap chair |
15,790 |
14,267 |
$978K |
| E2365 |
U1 sealed leadacid battery |
18,630 |
16,470 |
$522K |
| K0822 |
Pwc gp 2 std seat/back |
9,731 |
8,595 |
$360K |
| E2375 |
Non-expandable controller |
1,987 |
1,725 |
$198K |
| K0195 |
Elevating whlchair leg rests |
33,015 |
29,118 |
$190K |
| E2359 |
Gr34 sealed leadacid battery |
2,976 |
2,660 |
$165K |
| K0108 |
W/c component-accessory nos |
3,743 |
2,807 |
$159K |
| K0739 |
Repair/svc dme non-oxygen eq |
10,948 |
9,477 |
$107K |
| E2370 |
Pwr wc dr wh motor/gear comb |
854 |
528 |
$103K |
| E2366 |
Battery charger, single mode |
3,029 |
2,688 |
$95K |
| K0824 |
Pwc gp 2 hd seat/back |
1,263 |
1,092 |
$81K |
| E0973 |
W/ch access det adj armrest |
4,304 |
2,563 |
$81K |
| E2381 |
Pneum drive wheel tire |
3,740 |
3,305 |
$71K |
| K0015 |
Detach non-adj ht armrst rep |
1,828 |
1,087 |
$46K |
| K0800 |
Pov group 1 std up to 300lbs |
239 |
230 |
$42K |
| E2391 |
Solid caster tire |
4,272 |
3,746 |
$38K |
| E1020 |
Residual limb support system |
4,938 |
3,784 |
$36K |
| E0955 |
Cushioned headrest |
4,402 |
3,802 |
$33K |
| K0827 |
Pwc gp vhd cap chair |
352 |
312 |
$32K |
| E2208 |
Cylinder tank carrier |
1,307 |
1,172 |
$31K |
| E1226 |
Manual fully reclining back |
220 |
184 |
$20K |
| E2382 |
Tube, pneum wheel drive tire |
1,779 |
1,565 |
$12K |
| E2395 |
Caster wheel excludes tire |
415 |
378 |
$9K |
| E2374 |
Hand/chin ctrl std joystick |
134 |
115 |
$9K |
| E2390 |
Solid drive wheel tire |
504 |
460 |
$8K |
| E2386 |
Foam filled drive wheel tire |
228 |
200 |
$6K |
| E2603 |
Skin protect wc cus wd <22in |
306 |
263 |
$6K |
| K0040 |
Adjustable angle footplate |
377 |
314 |
$5K |
| E2363 |
Gr24 sealed leadacid battery |
15 |
14 |
$785.66 |
| E0990 |
Wheelchair elevating leg res |
37 |
28 |
$741.62 |
| E2394 |
Drive wheel excludes tire |
13 |
12 |
$463.40 |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
12 |
$100.97 |