| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
7,483 |
4,102 |
$1.61M |
| E1399 |
Durable medical equipment mi |
286 |
223 |
$322K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,999 |
4,693 |
$295K |
| K0800 |
Pov group 1 std up to 300lbs |
223 |
223 |
$261K |
| E1028 |
W/c manual swingaway |
1,635 |
1,282 |
$168K |
| E0240 |
Bath/shower chair |
109 |
81 |
$150K |
| E1161 |
Manual adult wc w tiltinspac |
348 |
347 |
$90K |
| E0973 |
W/ch access det adj armrest |
640 |
505 |
$55K |
| E0955 |
Cushioned headrest |
1,013 |
985 |
$53K |
| K0823 |
Pwc gp 2 std cap chair |
250 |
248 |
$28K |
| K0806 |
Pov group 2 std up to 300lbs |
13 |
13 |
$19K |
| K0801 |
Pov group 1 hd 301-450 lbs |
12 |
12 |
$19K |
| K0040 |
Adjustable angle footplate |
215 |
192 |
$19K |
| E0956 |
W/c lateral trunk/hip suppor |
90 |
77 |
$16K |
| E0978 |
W/c acc,saf belt pelv strap |
484 |
443 |
$12K |
| E0971 |
Wheelchair anti-tipping devi |
200 |
166 |
$11K |
| E0960 |
W/c shoulder harness/straps |
159 |
149 |
$11K |
| E2361 |
22nf sealed leadacid battery |
26 |
26 |
$6K |
| E2366 |
Battery charger, single mode |
12 |
12 |
$2K |
| K0733 |
12-24hr sealed lead acid |
12 |
12 |
$674.76 |
| E2213 |
Pneumatic prop tire insert |
12 |
12 |
$557.81 |
| K0019 |
Arm pad repl, each |
13 |
12 |
$327.34 |
| E0951 |
Loop heel |
16 |
12 |
$228.85 |