| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
59 |
51 |
$47K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
61 |
52 |
$31K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
16 |
13 |
$22K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
112 |
78 |
$20K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
53 |
39 |
$16K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
55 |
49 |
$8K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
35 |
29 |
$5K |
| K0040 |
Adjustable angle footplate, each |
29 |
26 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
42 |
28 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
14 |
12 |
$864.08 |