| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
3,420 |
3,023 |
$1.05M |
| E1007 |
Pwr seat combo w/shear |
217 |
203 |
$821K |
| K0005 |
Ultralightweight wheelchair |
234 |
216 |
$331K |
| E2311 |
Electro connect btw 2 sys |
279 |
263 |
$276K |
| E1028 |
W/c manual swingaway |
5,395 |
3,988 |
$242K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
75 |
73 |
$202K |
| E2620 |
Wc planar back cush wd <22in |
674 |
621 |
$174K |
| E0973 |
W/ch access det adj armrest |
1,710 |
1,236 |
$131K |
| E0955 |
Cushioned headrest |
4,116 |
3,666 |
$124K |
| K0108 |
W/c component-accessory nos |
714 |
452 |
$110K |
| E1012 |
Ctr mount pwr elev leg rest |
240 |
227 |
$88K |
| E2607 |
Skin pro/pos wc cus wd <22in |
453 |
416 |
$79K |
| E2231 |
Solid seat support base |
729 |
651 |
$65K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,148 |
1,070 |
$48K |
| E0971 |
Wheelchair anti-tipping devi |
1,247 |
870 |
$44K |
| E2361 |
22nf sealed leadacid battery |
403 |
378 |
$44K |
| E2377 |
Expandable controller, initl |
198 |
186 |
$40K |
| K0040 |
Adjustable angle footplate |
665 |
486 |
$38K |
| E2313 |
Pwc harness, expand control |
216 |
201 |
$33K |
| K0823 |
Pwc gp 2 std cap chair |
181 |
174 |
$25K |
| E0951 |
Loop heel |
574 |
421 |
$9K |
| E2611 |
Gen use back cush wdth <22in |
77 |
68 |
$8K |
| E2615 |
Pos back post/lat wdth <22in |
15 |
14 |
$6K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
14 |
13 |
$5K |
| E2363 |
Gr24 sealed leadacid battery |
25 |
24 |
$4K |
| E2624 |
Adj skin pro/pos cus<22in |
31 |
31 |
$4K |
| K0195 |
Elevating whlchair leg rests |
890 |
784 |
$3K |
| E0961 |
Wheelchair brake extension |
126 |
80 |
$3K |
| E2622 |
Adj skin pro w/c cus wd<22in |
13 |
13 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
58 |
55 |
$729.18 |
| E2601 |
Gen w/c cushion wdth < 22 in |
17 |
12 |
$372.62 |