| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
582 |
174 |
$72K |
| E1235 |
Wheelchair, pediatric size, rigid, adjustable, with seating system |
238 |
233 |
$43K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
194 |
102 |
$36K |
| E1399 |
Durable medical equipment, miscellaneous |
104 |
17 |
$24K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
94 |
89 |
$14K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
12 |
12 |
$4K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
31 |
27 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
97 |
92 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
94 |
90 |
$3K |
| K0040 |
Adjustable angle footplate, each |
29 |
28 |
$3K |
| E0950 |
Wheelchair accessory, tray, each |
32 |
28 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
30 |
28 |
$2K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
27 |
25 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
15 |
15 |
$477.75 |