| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0005 |
Ultralightweight wheelchair |
290 |
279 |
$82K |
| E2611 |
Gen use back cush wdth <22in |
290 |
279 |
$10K |
| E0990 |
Wheelchair elevating leg res |
289 |
278 |
$8K |
| E0260 |
Hosp bed semi-electr w/ matt |
347 |
346 |
$6K |
| E2602 |
Gen w/c cushion wdth >=22 in |
290 |
279 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
290 |
279 |
$3K |
| E0973 |
W/ch access det adj armrest |
75 |
74 |
$2K |
| E0961 |
Wheelchair brake extension |
290 |
279 |
$2K |
| K0001 |
Standard wheelchair |
152 |
152 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
18 |
18 |
$313.73 |
| E0163 |
Commode chair with fixed arm |
12 |
12 |
$136.45 |
| E0261 |
Hosp bed semi-electr w/o mat |
12 |
12 |
$90.37 |
| E0156 |
Walker seat attachment |
14 |
14 |
$67.43 |