| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
893 |
728 |
$1.95M |
| K0108 |
W/c component-accessory nos |
2,500 |
1,457 |
$961K |
| K0009 |
Other manual wheelchair/base |
30 |
30 |
$189K |
| E1028 |
W/c manual swingaway |
2,007 |
897 |
$142K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,988 |
2,396 |
$140K |
| E1161 |
Manual adult wc w tiltinspac |
84 |
63 |
$42K |
| E0955 |
Cushioned headrest |
581 |
471 |
$30K |
| E2617 |
Custom fab w/c back cushion |
13 |
12 |
$22K |
| E0973 |
W/ch access det adj armrest |
136 |
91 |
$10K |
| E0960 |
W/c shoulder harness/straps |
166 |
131 |
$7K |
| E0956 |
W/c lateral trunk/hip suppor |
47 |
26 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
179 |
143 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
37 |
28 |
$2K |
| K0040 |
Adjustable angle footplate |
25 |
16 |
$2K |
| E0951 |
Loop heel |
48 |
31 |
$775.96 |