| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,779 |
814 |
$2.01M |
| K0108 |
W/c component-accessory nos |
3,393 |
1,168 |
$607K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,720 |
2,291 |
$144K |
| E1028 |
W/c manual swingaway |
987 |
661 |
$138K |
| E1236 |
Folding ped wc adjustable |
21 |
14 |
$18K |
| E0955 |
Cushioned headrest |
134 |
122 |
$17K |
| E0973 |
W/ch access det adj armrest |
126 |
109 |
$15K |
| E0960 |
W/c shoulder harness/straps |
249 |
212 |
$14K |
| E0978 |
W/c acc,saf belt pelv strap |
202 |
181 |
$5K |
| E1161 |
Manual adult wc w tiltinspac |
28 |
28 |
$4K |
| K0040 |
Adjustable angle footplate |
35 |
25 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
16 |
14 |
$2K |
| E0966 |
Wheelchair head rest extensi |
18 |
14 |
$683.06 |
| E0971 |
Wheelchair anti-tipping devi |
14 |
12 |
$670.52 |