| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
702 |
425 |
$621K |
| E1028 |
W/c manual swingaway |
1,558 |
895 |
$193K |
| K0108 |
W/c component-accessory nos |
892 |
560 |
$126K |
| E0955 |
Cushioned headrest |
573 |
456 |
$45K |
| K0739 |
Repair/svc dme non-oxygen eq |
460 |
348 |
$22K |
| E0973 |
W/ch access det adj armrest |
274 |
182 |
$22K |
| E0956 |
W/c lateral trunk/hip suppor |
124 |
68 |
$13K |
| E0960 |
W/c shoulder harness/straps |
83 |
72 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
163 |
106 |
$4K |
| K0040 |
Adjustable angle footplate |
118 |
61 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
178 |
149 |
$3K |