| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,513 |
1,373 |
$486K |
| E1161 |
Manual adult wc w tiltinspac |
1,332 |
1,289 |
$381K |
| E1028 |
W/c manual swingaway |
3,819 |
2,604 |
$212K |
| E2311 |
Electro connect btw 2 sys |
73 |
70 |
$139K |
| K0005 |
Ultralightweight wheelchair |
76 |
67 |
$114K |
| E1012 |
Ctr mount pwr elev leg rest |
88 |
81 |
$103K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,215 |
2,006 |
$95K |
| E0955 |
Cushioned headrest |
1,760 |
1,676 |
$84K |
| E0973 |
W/ch access det adj armrest |
833 |
694 |
$83K |
| E2607 |
Skin pro/pos wc cus wd <22in |
319 |
299 |
$61K |
| K0823 |
Pwc gp 2 std cap chair |
110 |
107 |
$52K |
| E1002 |
Pwr seat tilt |
14 |
14 |
$51K |
| K0004 |
High strength ltwt whlchr |
716 |
700 |
$37K |
| E0971 |
Wheelchair anti-tipping devi |
676 |
631 |
$37K |
| E1399 |
Durable medical equipment mi |
26 |
12 |
$35K |
| K0040 |
Adjustable angle footplate |
429 |
346 |
$29K |
| E2300 |
Pwr seat elevation sys |
12 |
12 |
$23K |
| E2361 |
22nf sealed leadacid battery |
130 |
121 |
$23K |
| E2620 |
Wc planar back cush wd <22in |
74 |
70 |
$22K |
| E0978 |
W/c acc,saf belt pelv strap |
665 |
633 |
$16K |
| E2211 |
Pneumatic propulsion tire |
187 |
173 |
$10K |
| E0951 |
Loop heel |
390 |
359 |
$8K |
| E2213 |
Pneumatic prop tire insert |
179 |
168 |
$8K |
| E0961 |
Wheelchair brake extension |
174 |
168 |
$7K |
| E2611 |
Gen use back cush wdth <22in |
39 |
38 |
$6K |
| E2613 |
Position back cush wd <22in |
14 |
13 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
12 |
12 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
14 |
12 |
$2K |
| E2231 |
Solid seat support base |
14 |
14 |
$1K |
| E2392 |
Solid caster tire, integrate |
15 |
12 |
$1K |
| K0019 |
Arm pad repl, each |
67 |
63 |
$1K |