| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
6,496 |
1,851 |
$475K |
| E1399 |
Durable medical equipment mi |
861 |
179 |
$254K |
| E1028 |
W/c manual swingaway |
5,369 |
2,453 |
$226K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,853 |
3,022 |
$124K |
| E1161 |
Manual adult wc w tiltinspac |
195 |
154 |
$103K |
| K0823 |
Pwc gp 2 std cap chair |
1,070 |
762 |
$102K |
| E0955 |
Cushioned headrest |
1,638 |
1,002 |
$81K |
| E0973 |
W/ch access det adj armrest |
962 |
426 |
$34K |
| E2609 |
Custom fabricate w/c cushion |
25 |
12 |
$25K |
| E0960 |
W/c shoulder harness/straps |
469 |
265 |
$23K |
| K0040 |
Adjustable angle footplate |
270 |
131 |
$15K |
| E0978 |
W/c acc,saf belt pelv strap |
881 |
548 |
$13K |
| E0971 |
Wheelchair anti-tipping devi |
303 |
172 |
$11K |
| E2392 |
Solid caster tire, integrate |
325 |
167 |
$11K |
| A9900 |
Supply/accessory/service |
28 |
15 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
41 |
12 |
$2K |
| E0630 |
Patient lift hydraulic |
29 |
29 |
$2K |
| E2394 |
Drive wheel excludes tire |
35 |
24 |
$989.78 |
| K0019 |
Arm pad repl, each |
112 |
42 |
$534.14 |
| E2386 |
Foam filled drive wheel tire |
30 |
12 |
$494.70 |
| E0951 |
Loop heel |
35 |
13 |
$218.13 |
| K0816 |
Pwc gp 1 std cap chair |
16 |
12 |
$35.17 |