| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
828 |
341 |
$71K |
| E1028 |
W/c manual swingaway |
746 |
361 |
$59K |
| E1161 |
Manual adult wc w tiltinspac |
286 |
239 |
$52K |
| E2617 |
Custom fab w/c back cushion |
19 |
12 |
$38K |
| E0240 |
Bath/shower chair |
18 |
12 |
$31K |
| K0823 |
Pwc gp 2 std cap chair |
85 |
63 |
$24K |
| E0955 |
Cushioned headrest |
441 |
318 |
$23K |
| E0630 |
Patient lift hydraulic |
422 |
322 |
$22K |
| E1399 |
Durable medical equipment mi |
22 |
12 |
$17K |
| K0739 |
Repair/svc dme non-oxygen eq |
724 |
530 |
$17K |
| E0973 |
W/ch access det adj armrest |
129 |
83 |
$13K |
| K0040 |
Adjustable angle footplate |
115 |
73 |
$10K |
| E0960 |
W/c shoulder harness/straps |
135 |
88 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
141 |
92 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
250 |
168 |
$6K |
| E2624 |
Adj skin pro/pos cus<22in |
49 |
28 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
27 |
12 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
15 |
12 |
$2K |
| E0261 |
Hosp bed semi-electr w/o mat |
42 |
27 |
$2K |
| E0950 |
Tray |
17 |
12 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
13 |
12 |
$436.15 |
| K0003 |
Lightweight wheelchair |
16 |
13 |
$246.90 |