| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
1,925 |
994 |
$125K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,068 |
1,533 |
$98K |
| E1028 |
W/c manual swingaway |
1,457 |
921 |
$75K |
| E1161 |
Manual adult wc w tiltinspac |
267 |
194 |
$27K |
| E0955 |
Cushioned headrest |
583 |
496 |
$26K |
| E1236 |
Folding ped wc adjustable |
183 |
146 |
$22K |
| E1399 |
Durable medical equipment mi |
25 |
14 |
$19K |
| K0823 |
Pwc gp 2 std cap chair |
45 |
39 |
$8K |
| E0973 |
W/ch access det adj armrest |
147 |
90 |
$8K |
| K0004 |
High strength ltwt whlchr |
149 |
112 |
$3K |
| K0040 |
Adjustable angle footplate |
17 |
13 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
22 |
15 |
$1K |
| E0960 |
W/c shoulder harness/straps |
16 |
12 |
$905.15 |
| E0978 |
W/c acc,saf belt pelv strap |
26 |
19 |
$548.41 |