| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Whlchr special size/constrc |
329 |
155 |
$891K |
| E1399 |
Durable medical equipment mi |
1,756 |
402 |
$886K |
| K0108 |
W/c component-accessory nos |
3,138 |
1,143 |
$240K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,042 |
2,191 |
$223K |
| E1028 |
W/c manual swingaway |
3,898 |
1,917 |
$167K |
| E0955 |
Cushioned headrest |
1,433 |
1,226 |
$46K |
| E1161 |
Manual adult wc w tiltinspac |
340 |
307 |
$22K |
| E0973 |
W/ch access det adj armrest |
263 |
182 |
$18K |
| K0040 |
Adjustable angle footplate |
227 |
144 |
$10K |
| E0978 |
W/c acc,saf belt pelv strap |
315 |
255 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
58 |
24 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
103 |
77 |
$4K |
| E2213 |
Pneumatic prop tire insert |
61 |
55 |
$2K |
| E2211 |
Pneumatic propulsion tire |
29 |
25 |
$1K |
| E0960 |
W/c shoulder harness/straps |
20 |
18 |
$940.61 |
| K0823 |
Pwc gp 2 std cap chair |
14 |
12 |
$385.23 |
| E0951 |
Loop heel |
28 |
13 |
$195.24 |