| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
582 |
174 |
$72K |
| E1235 |
Rigid ped wc adjustable |
238 |
233 |
$43K |
| E1028 |
W/c manual swingaway |
194 |
102 |
$36K |
| E1399 |
Durable medical equipment mi |
104 |
17 |
$24K |
| E0973 |
W/ch access det adj armrest |
94 |
89 |
$14K |
| T2029 |
Special med equip, noswaiver |
12 |
12 |
$4K |
| E0955 |
Cushioned headrest |
31 |
27 |
$4K |
| K0739 |
Repair/svc dme non-oxygen eq |
97 |
92 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
94 |
90 |
$3K |
| K0040 |
Adjustable angle footplate |
29 |
28 |
$3K |
| E0950 |
Tray |
32 |
28 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
30 |
28 |
$2K |
| E0960 |
W/c shoulder harness/straps |
27 |
25 |
$2K |
| T4541 |
Large disposable underpad |
15 |
15 |
$477.75 |