| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
3,331 |
2,444 |
$331K |
| K0108 |
W/c component-accessory nos |
2,389 |
923 |
$266K |
| E1028 |
W/c manual swingaway |
7,239 |
4,421 |
$199K |
| E1161 |
Manual adult wc w tiltinspac |
1,864 |
1,235 |
$180K |
| E0973 |
W/ch access det adj armrest |
2,494 |
1,327 |
$105K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,263 |
1,628 |
$57K |
| E0955 |
Cushioned headrest |
2,409 |
1,624 |
$51K |
| K0005 |
Ultralightweight wheelchair |
51 |
50 |
$49K |
| A9999 |
Dme supply or accessory, nos |
351 |
33 |
$42K |
| K0825 |
Pwc gp 2 hd cap chair |
123 |
102 |
$36K |
| E2361 |
22nf sealed leadacid battery |
555 |
383 |
$32K |
| E0971 |
Wheelchair anti-tipping devi |
628 |
366 |
$14K |
| E2311 |
Electro connect btw 2 sys |
16 |
12 |
$14K |
| E2620 |
Wc planar back cush wd <22in |
73 |
66 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
82 |
69 |
$9K |
| K0040 |
Adjustable angle footplate |
145 |
106 |
$6K |
| E2365 |
U1 sealed leadacid battery |
69 |
65 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
448 |
306 |
$5K |
| E1012 |
Ctr mount pwr elev leg rest |
19 |
13 |
$4K |
| E2611 |
Gen use back cush wdth <22in |
14 |
12 |
$2K |
| E2231 |
Solid seat support base |
14 |
13 |
$962.00 |
| E2392 |
Solid caster tire, integrate |
37 |
12 |
$523.32 |
| E2213 |
Pneumatic prop tire insert |
18 |
12 |
$358.03 |
| E0951 |
Loop heel |
14 |
12 |
$250.80 |