| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2609 |
Custom fabricate w/c cushion |
5,389 |
4,343 |
$5.08M |
| E2617 |
Custom fab w/c back cushion |
4,879 |
3,982 |
$4.97M |
| E1161 |
Manual adult wc w tiltinspac |
3,257 |
2,651 |
$4.09M |
| E1007 |
Pwr seat combo w/shear |
861 |
681 |
$3.66M |
| K0108 |
W/c component-accessory nos |
10,859 |
5,783 |
$2.77M |
| E1028 |
W/c manual swingaway |
10,109 |
6,300 |
$1.98M |
| K0005 |
Ultralightweight wheelchair |
1,351 |
1,110 |
$1.95M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
458 |
373 |
$1.70M |
| E2311 |
Electro connect btw 2 sys |
1,229 |
973 |
$1.59M |
| E1012 |
Ctr mount pwr elev leg rest |
1,098 |
874 |
$1.50M |
| E0956 |
W/c lateral trunk/hip suppor |
4,492 |
3,123 |
$675K |
| E2203 |
Frame depth less than 22 in |
1,924 |
1,605 |
$645K |
| E0955 |
Cushioned headrest |
5,047 |
4,079 |
$593K |
| E0973 |
W/ch access det adj armrest |
4,995 |
3,805 |
$567K |
| E0990 |
Wheelchair elevating leg res |
3,405 |
2,732 |
$458K |
| K0040 |
Adjustable angle footplate |
4,789 |
3,689 |
$445K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,240 |
1,046 |
$331K |
| E2377 |
Expandable controller, initl |
1,153 |
921 |
$272K |
| E0986 |
Man w/c powr assist syst |
90 |
76 |
$265K |
| E2231 |
Solid seat support base |
2,266 |
1,840 |
$232K |
| E0971 |
Wheelchair anti-tipping devi |
3,951 |
3,091 |
$227K |
| E2313 |
Pwc harness, expand control |
1,188 |
942 |
$211K |
| E2361 |
22nf sealed leadacid battery |
889 |
736 |
$155K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,858 |
3,175 |
$138K |
| E2363 |
Gr24 sealed leadacid battery |
518 |
417 |
$114K |
| E0961 |
Wheelchair brake extension |
2,977 |
2,344 |
$97K |
| K0823 |
Pwc gp 2 std cap chair |
660 |
565 |
$93K |
| E2213 |
Pneumatic prop tire insert |
1,933 |
1,569 |
$79K |
| E2204 |
Frame depth 22 to 25 in |
131 |
114 |
$71K |
| E0954 |
Foot box, any type each foot |
382 |
261 |
$51K |
| E0951 |
Loop heel |
2,183 |
1,396 |
$38K |
| E2300 |
Pwr seat elevation sys |
23 |
15 |
$36K |
| E0978 |
W/c acc,saf belt pelv strap |
1,252 |
1,051 |
$32K |
| E1225 |
Manual semi-reclining back |
142 |
92 |
$15K |
| E2620 |
Wc planar back cush wd <22in |
38 |
30 |
$10K |
| E0953 |
W/c lateral thigh/knee sup |
19 |
12 |
$4K |
| E1226 |
Manual fully reclining back |
13 |
13 |
$4K |
| K0195 |
Elevating whlchair leg rests |
1,252 |
1,065 |
$3K |
| E2211 |
Pneumatic propulsion tire |
51 |
45 |
$2K |
| E2208 |
Cylinder tank carrier |
26 |
26 |
$2K |
| E2607 |
Skin pro/pos wc cus wd <22in |
20 |
14 |
$2K |
| E2323 |
Special joystick handle |
36 |
29 |
$1K |
| K0019 |
Arm pad repl, each |
29 |
25 |
$394.43 |
| K0004 |
High strength ltwt whlchr |
14 |
12 |
$69.88 |