| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0973 |
W/ch access det adj armrest |
389 |
364 |
$62K |
| K0005 |
Ultralightweight wheelchair |
29 |
26 |
$56K |
| E1028 |
W/c manual swingaway |
237 |
220 |
$49K |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$31K |
| E2231 |
Solid seat support base |
146 |
142 |
$19K |
| E0955 |
Cushioned headrest |
99 |
96 |
$16K |
| E2611 |
Gen use back cush wdth <22in |
53 |
51 |
$14K |
| E2615 |
Pos back post/lat wdth <22in |
27 |
26 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
108 |
100 |
$7K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$6K |
| K0739 |
Repair/svc dme non-oxygen eq |
69 |
66 |
$6K |
| K0108 |
W/c component-accessory nos |
19 |
14 |
$2K |
| E2603 |
Skin protect wc cus wd <22in |
13 |
13 |
$2K |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$553.77 |