| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0650 |
Lso sc r ant/pos pnl pre ots |
522 |
521 |
$213K |
| K0003 |
Lightweight wheelchair |
5,357 |
5,329 |
$63K |
| L1833 |
Ko adj jnt pos r sup pre ots |
403 |
259 |
$40K |
| E2611 |
Gen use back cush wdth <22in |
614 |
609 |
$39K |
| E0143 |
Walker folding wheeled w/o s |
1,669 |
1,659 |
$31K |
| E1007 |
Pwr seat combo w/shear |
12 |
12 |
$21K |
| E0973 |
W/ch access det adj armrest |
597 |
561 |
$17K |
| E0245 |
Tub stool or bench |
251 |
249 |
$14K |
| E0156 |
Walker seat attachment |
1,306 |
1,302 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
530 |
495 |
$7K |
| E2311 |
Electro connect btw 2 sys |
12 |
12 |
$6K |
| L2397 |
Suspension sleeve lower ext |
1,384 |
1,114 |
$5K |
| K0005 |
Ultralightweight wheelchair |
96 |
96 |
$4K |
| E0951 |
Loop heel |
462 |
428 |
$4K |
| E0372 |
Powered air mattress overlay |
93 |
79 |
$3K |
| E1010 |
Add pwr leg elevation |
12 |
12 |
$3K |
| L2810 |
Knee control condylar pad |
117 |
67 |
$2K |
| E2361 |
22nf sealed leadacid battery |
26 |
25 |
$1K |
| E2377 |
Expandable controller, initl |
12 |
12 |
$1K |
| E1028 |
W/c manual swingaway |
40 |
24 |
$1K |
| L0464 |
Tlso 4mod sacro-scap pre |
65 |
65 |
$1K |
| L3170 |
Foot plas heel stabi pre ots |
39 |
39 |
$809.80 |
| E2313 |
Pwc harness, expand control |
12 |
12 |
$631.11 |
| E2601 |
Gen w/c cushion wdth < 22 in |
124 |
124 |
$242.04 |
| E0978 |
W/c acc,saf belt pelv strap |
96 |
96 |
$89.94 |
| L0651 |
Lso sag-co shell pnl pre ots |
96 |
96 |
$64.62 |