| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
435 |
280 |
$942K |
| K0108 |
W/c component-accessory nos |
2,637 |
1,079 |
$430K |
| E1028 |
W/c manual swingaway |
3,697 |
1,264 |
$282K |
| E1161 |
Manual adult wc w tiltinspac |
296 |
164 |
$128K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,248 |
782 |
$33K |
| E0973 |
W/ch access det adj armrest |
174 |
114 |
$19K |
| K0040 |
Adjustable angle footplate |
175 |
109 |
$12K |
| E0978 |
W/c acc,saf belt pelv strap |
328 |
257 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
163 |
103 |
$6K |
| E0960 |
W/c shoulder harness/straps |
77 |
68 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
17 |
14 |
$3K |
| E2211 |
Pneumatic propulsion tire |
69 |
42 |
$2K |