| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
415 |
408 |
$265K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,025 |
408 |
$253K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
707 |
599 |
$59K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
764 |
684 |
$55K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
438 |
428 |
$29K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
12 |
12 |
$22K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
28 |
26 |
$3K |
| K0040 |
Adjustable angle footplate, each |
28 |
26 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
25 |
24 |
$2K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
28 |
26 |
$1K |