| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,768 |
1,436 |
$263K |
| K0823 |
Pwc gp 2 std cap chair |
2,629 |
2,045 |
$202K |
| E1028 |
W/c manual swingaway |
5,278 |
3,284 |
$177K |
| E1161 |
Manual adult wc w tiltinspac |
992 |
785 |
$81K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,543 |
2,866 |
$67K |
| E0973 |
W/ch access det adj armrest |
1,064 |
713 |
$55K |
| E0955 |
Cushioned headrest |
1,491 |
1,142 |
$39K |
| K0004 |
High strength ltwt whlchr |
1,068 |
845 |
$32K |
| K0825 |
Pwc gp 2 hd cap chair |
166 |
146 |
$23K |
| E2361 |
22nf sealed leadacid battery |
189 |
148 |
$13K |
| E1399 |
Durable medical equipment mi |
61 |
12 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
134 |
92 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
178 |
127 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
25 |
12 |
$168.90 |
| K0019 |
Arm pad repl, each |
19 |
13 |
$124.14 |