| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
1,238 |
1,227 |
$55K |
| K0001 |
Standard wheelchair |
1,923 |
1,904 |
$17K |
| E0973 |
W/ch access det adj armrest |
576 |
329 |
$10K |
| K0003 |
Lightweight wheelchair |
794 |
790 |
$9K |
| K0462 |
Temporary replacement eqpmnt |
42 |
42 |
$9K |
| K0739 |
Repair/svc dme non-oxygen eq |
97 |
96 |
$5K |
| K0195 |
Elevating whlchair leg rests |
2,058 |
2,039 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
27 |
26 |
$2K |
| E1031 |
Rollabout chair with casters |
104 |
104 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
119 |
93 |
$1K |
| E0961 |
Wheelchair brake extension |
64 |
38 |
$626.61 |
| E0951 |
Loop heel |
132 |
103 |
$623.56 |
| E2375 |
Non-expandable controller |
12 |
12 |
$320.85 |
| E2386 |
Foam filled drive wheel tire |
26 |
13 |
$143.26 |
| E2219 |
Foam caster tire any size ea |
24 |
12 |
$126.36 |
| E2366 |
Battery charger, single mode |
13 |
13 |
$122.68 |
| E2394 |
Drive wheel excludes tire |
26 |
13 |
$75.04 |
| E0978 |
W/c acc,saf belt pelv strap |
50 |
48 |
$74.39 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$42.80 |