| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,417 |
1,077 |
$368K |
| E1161 |
Manual adult wc w tiltinspac |
1,330 |
1,146 |
$207K |
| E1028 |
W/c manual swingaway |
3,225 |
1,771 |
$82K |
| K0739 |
Repair/svc dme non-oxygen eq |
728 |
636 |
$75K |
| E0955 |
Cushioned headrest |
1,693 |
1,437 |
$37K |
| E0973 |
W/ch access det adj armrest |
155 |
96 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
323 |
265 |
$4K |
| K0040 |
Adjustable angle footplate |
84 |
54 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
83 |
52 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
52 |
27 |
$2K |
| E2213 |
Pneumatic prop tire insert |
38 |
24 |
$766.24 |
| E2211 |
Pneumatic propulsion tire |
14 |
13 |
$544.40 |