| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
946 |
535 |
$193K |
| E1028 |
W/c manual swingaway |
458 |
269 |
$50K |
| E0973 |
W/ch access det adj armrest |
158 |
113 |
$18K |
| K0040 |
Adjustable angle footplate |
197 |
145 |
$16K |
| E0978 |
W/c acc,saf belt pelv strap |
325 |
265 |
$15K |
| E0955 |
Cushioned headrest |
115 |
93 |
$14K |
| E0971 |
Wheelchair anti-tipping devi |
145 |
114 |
$11K |
| E0960 |
W/c shoulder harness/straps |
111 |
83 |
$8K |
| E2607 |
Skin pro/pos wc cus wd <22in |
30 |
26 |
$6K |
| E0956 |
W/c lateral trunk/hip suppor |
22 |
12 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
57 |
44 |
$2K |
| E2213 |
Pneumatic prop tire insert |
14 |
13 |
$539.11 |