| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
7,790 |
3,203 |
$568K |
| K0823 |
Pwc gp 2 std cap chair |
3,934 |
2,735 |
$276K |
| E1028 |
W/c manual swingaway |
7,883 |
4,288 |
$266K |
| E1399 |
Durable medical equipment mi |
674 |
197 |
$241K |
| E1161 |
Manual adult wc w tiltinspac |
2,043 |
1,310 |
$188K |
| K0739 |
Repair/svc dme non-oxygen eq |
8,606 |
5,573 |
$157K |
| E0973 |
W/ch access det adj armrest |
2,849 |
1,692 |
$150K |
| E0955 |
Cushioned headrest |
2,458 |
1,592 |
$82K |
| E2361 |
22nf sealed leadacid battery |
1,184 |
825 |
$72K |
| K0825 |
Pwc gp 2 hd cap chair |
425 |
348 |
$62K |
| E2607 |
Skin pro/pos wc cus wd <22in |
338 |
252 |
$39K |
| E2392 |
Solid caster tire, integrate |
1,089 |
598 |
$38K |
| K0004 |
High strength ltwt whlchr |
875 |
563 |
$24K |
| E0971 |
Wheelchair anti-tipping devi |
747 |
555 |
$23K |
| K0040 |
Adjustable angle footplate |
352 |
241 |
$17K |
| E0956 |
W/c lateral trunk/hip suppor |
240 |
137 |
$14K |
| E2386 |
Foam filled drive wheel tire |
209 |
131 |
$12K |
| E0978 |
W/c acc,saf belt pelv strap |
890 |
651 |
$12K |
| E2394 |
Drive wheel excludes tire |
267 |
175 |
$8K |
| E2613 |
Position back cush wd <22in |
28 |
24 |
$7K |
| E0960 |
W/c shoulder harness/straps |
59 |
51 |
$4K |
| K0019 |
Arm pad repl, each |
409 |
266 |
$2K |
| E2366 |
Battery charger, single mode |
34 |
27 |
$2K |
| E2365 |
U1 sealed leadacid battery |
21 |
17 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
15 |
12 |
$1K |
| E2624 |
Adj skin pro/pos cus<22in |
15 |
12 |
$1K |
| E2374 |
Hand/chin ctrl std joystick |
24 |
16 |
$1K |
| E0950 |
Tray |
14 |
12 |
$963.62 |
| E2601 |
Gen w/c cushion wdth < 22 in |
47 |
37 |
$835.30 |
| E2213 |
Pneumatic prop tire insert |
15 |
12 |
$365.35 |
| E0951 |
Loop heel |
13 |
12 |
$133.67 |