| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1028 |
W/c manual swingaway |
3,884 |
2,819 |
$356K |
| K0108 |
W/c component-accessory nos |
1,808 |
1,222 |
$330K |
| K0004 |
High strength ltwt whlchr |
5,273 |
3,828 |
$321K |
| E0973 |
W/ch access det adj armrest |
1,302 |
1,057 |
$122K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,734 |
4,002 |
$102K |
| Z0160 |
|
732 |
469 |
$56K |
| K0823 |
Pwc gp 2 std cap chair |
392 |
358 |
$55K |
| E0955 |
Cushioned headrest |
569 |
497 |
$31K |
| E0971 |
Wheelchair anti-tipping devi |
579 |
470 |
$28K |
| E0978 |
W/c acc,saf belt pelv strap |
1,001 |
818 |
$23K |
| E2620 |
Wc planar back cush wd <22in |
15 |
14 |
$8K |
| E2361 |
22nf sealed leadacid battery |
33 |
28 |
$4K |
| E0951 |
Loop heel |
158 |
130 |
$3K |
| K0040 |
Adjustable angle footplate |
26 |
24 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
66 |
51 |
$3K |
| E1161 |
Manual adult wc w tiltinspac |
24 |
24 |
$1K |
| K0019 |
Arm pad repl, each |
17 |
14 |
$351.15 |