| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,982 |
2,379 |
$391K |
| E1028 |
W/c manual swingaway |
6,148 |
3,686 |
$340K |
| E1035 |
Patient transfer system <300 |
71 |
63 |
$309K |
| E1161 |
Manual adult wc w tiltinspac |
1,240 |
1,100 |
$184K |
| E0240 |
Bath/shower chair |
126 |
119 |
$161K |
| E1399 |
Durable medical equipment mi |
200 |
91 |
$152K |
| E0973 |
W/ch access det adj armrest |
1,725 |
1,254 |
$113K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,612 |
3,235 |
$90K |
| K0823 |
Pwc gp 2 std cap chair |
815 |
694 |
$72K |
| E0955 |
Cushioned headrest |
2,012 |
1,882 |
$71K |
| K0004 |
High strength ltwt whlchr |
1,406 |
1,195 |
$57K |
| E0971 |
Wheelchair anti-tipping devi |
1,041 |
886 |
$43K |
| K0005 |
Ultralightweight wheelchair |
37 |
27 |
$32K |
| K0040 |
Adjustable angle footplate |
443 |
367 |
$29K |
| E2607 |
Skin pro/pos wc cus wd <22in |
175 |
161 |
$22K |
| E0978 |
W/c acc,saf belt pelv strap |
1,143 |
1,021 |
$22K |
| E2613 |
Position back cush wd <22in |
42 |
42 |
$10K |
| E0960 |
W/c shoulder harness/straps |
155 |
149 |
$9K |
| E0950 |
Tray |
112 |
97 |
$8K |
| E0956 |
W/c lateral trunk/hip suppor |
118 |
62 |
$7K |
| E2620 |
Wc planar back cush wd <22in |
15 |
13 |
$3K |
| E0951 |
Loop heel |
196 |
152 |
$3K |
| E0961 |
Wheelchair brake extension |
92 |
70 |
$2K |
| E1020 |
Residual limb support system |
63 |
50 |
$2K |
| E2386 |
Foam filled drive wheel tire |
28 |
14 |
$951.52 |
| E2601 |
Gen w/c cushion wdth < 22 in |
24 |
24 |
$562.03 |
| E2392 |
Solid caster tire, integrate |
29 |
16 |
$528.95 |
| K0019 |
Arm pad repl, each |
13 |
12 |
$54.89 |