| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
121 |
105 |
$596K |
| E2311 |
Electro connect btw 2 sys |
133 |
115 |
$174K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
25 |
25 |
$130K |
| E1028 |
W/c manual swingaway |
463 |
158 |
$51K |
| E2377 |
Expandable controller, initl |
121 |
104 |
$37K |
| E1012 |
Ctr mount pwr elev leg rest |
47 |
39 |
$24K |
| E1390 |
Oxygen concentrator |
474 |
470 |
$15K |
| E2313 |
Pwc harness, expand control |
81 |
67 |
$15K |
| E0955 |
Cushioned headrest |
91 |
79 |
$10K |
| E2363 |
Gr24 sealed leadacid battery |
33 |
26 |
$6K |
| E1029 |
W/c vent tray fixed |
13 |
13 |
$3K |
| E0431 |
Portable gaseous 02 |
318 |
316 |
$2K |
| E0973 |
W/ch access det adj armrest |
64 |
26 |
$1K |
| K0040 |
Adjustable angle footplate |
13 |
13 |
$515.84 |
| E0994 |
Wheelchair arm rest |
31 |
25 |
$432.59 |
| E0978 |
W/c acc,saf belt pelv strap |
31 |
25 |
$284.97 |
| E0995 |
Wc calf rest, pad replacemnt |
31 |
25 |
$112.80 |