| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
587 |
319 |
$433K |
| K0108 |
W/c component-accessory nos |
1,721 |
751 |
$183K |
| E1028 |
W/c manual swingaway |
3,255 |
1,586 |
$139K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,100 |
1,937 |
$108K |
| E0240 |
Bath/shower chair |
41 |
38 |
$51K |
| A9900 |
Supply/accessory/service |
212 |
31 |
$39K |
| E0955 |
Cushioned headrest |
663 |
631 |
$26K |
| E1161 |
Manual adult wc w tiltinspac |
201 |
198 |
$17K |
| K0823 |
Pwc gp 2 std cap chair |
74 |
74 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
54 |
26 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
56 |
50 |
$1K |
| 97542 |
|
30 |
13 |
$1K |
| E0960 |
W/c shoulder harness/straps |
15 |
13 |
$807.76 |
| E2392 |
Solid caster tire, integrate |
13 |
12 |
$781.28 |