| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
828 |
341 |
$71K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
746 |
361 |
$59K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
286 |
239 |
$52K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
19 |
12 |
$38K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
18 |
12 |
$31K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
85 |
63 |
$24K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
441 |
318 |
$23K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
422 |
322 |
$22K |
| E1399 |
Durable medical equipment, miscellaneous |
22 |
12 |
$17K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
724 |
530 |
$17K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
129 |
83 |
$13K |
| K0040 |
Adjustable angle footplate, each |
115 |
73 |
$10K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
135 |
88 |
$9K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
141 |
92 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
250 |
168 |
$6K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
49 |
28 |
$5K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
27 |
12 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
15 |
12 |
$2K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
42 |
27 |
$2K |
| E0950 |
Wheelchair accessory, tray, each |
17 |
12 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
13 |
12 |
$436.15 |
| K0003 |
Lightweight wheelchair |
16 |
13 |
$246.90 |