| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
853 |
539 |
$1.71M |
| K0108 |
W/c component-accessory nos |
1,501 |
808 |
$439K |
| E1028 |
W/c manual swingaway |
1,170 |
608 |
$113K |
| K0739 |
Repair/svc dme non-oxygen eq |
743 |
573 |
$57K |
| E0973 |
W/ch access det adj armrest |
348 |
261 |
$28K |
| E0955 |
Cushioned headrest |
257 |
200 |
$19K |
| E0956 |
W/c lateral trunk/hip suppor |
66 |
50 |
$9K |
| K0040 |
Adjustable angle footplate |
177 |
123 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
291 |
230 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
83 |
53 |
$3K |
| E0960 |
W/c shoulder harness/straps |
53 |
44 |
$3K |
| E0950 |
Tray |
47 |
37 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
15 |
12 |
$1K |
| E0951 |
Loop heel |
40 |
26 |
$426.12 |