| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
487 |
317 |
$927K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,389 |
616 |
$449K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,250 |
673 |
$71K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
182 |
145 |
$36K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
526 |
424 |
$22K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
103 |
67 |
$9K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
115 |
91 |
$6K |
| K0040 |
Adjustable angle footplate, each |
74 |
51 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
72 |
53 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
62 |
53 |
$2K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
32 |
29 |
$2K |