| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
966 |
453 |
$139K |
| E1028 |
W/c manual swingaway |
4,240 |
1,577 |
$59K |
| E1161 |
Manual adult wc w tiltinspac |
969 |
634 |
$53K |
| E1007 |
Pwr seat combo w/shear |
14 |
12 |
$41K |
| E1399 |
Durable medical equipment mi |
12 |
12 |
$38K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,073 |
726 |
$31K |
| K0823 |
Pwc gp 2 std cap chair |
239 |
183 |
$29K |
| E0973 |
W/ch access det adj armrest |
634 |
311 |
$20K |
| E0955 |
Cushioned headrest |
1,447 |
969 |
$16K |
| E0971 |
Wheelchair anti-tipping devi |
224 |
91 |
$2K |
| E2361 |
22nf sealed leadacid battery |
36 |
24 |
$1K |
| E2607 |
Skin pro/pos wc cus wd <22in |
25 |
13 |
$518.54 |
| K0040 |
Adjustable angle footplate |
20 |
12 |
$485.76 |
| E0960 |
W/c shoulder harness/straps |
14 |
12 |
$221.94 |
| E0978 |
W/c acc,saf belt pelv strap |
13 |
12 |
$144.43 |