| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0861 |
Pwc gp3 std mult pow opt s/b |
174 |
111 |
$238K |
| E1008 |
Pwr seat combo pwr shear |
209 |
137 |
$148K |
| E2311 |
Electro connect btw 2 sys |
362 |
238 |
$63K |
| E1012 |
Ctr mount pwr elev leg rest |
388 |
244 |
$26K |
| E2313 |
Pwc harness, expand control |
358 |
237 |
$24K |
| E2377 |
Expandable controller, initl |
350 |
229 |
$17K |
| E1028 |
W/c manual swingaway |
1,306 |
399 |
$13K |
| K0823 |
Pwc gp 2 std cap chair |
532 |
412 |
$10K |
| E1007 |
Pwr seat combo w/shear |
20 |
12 |
$9K |
| K0739 |
Repair/svc dme non-oxygen eq |
315 |
175 |
$7K |
| E2359 |
Gr34 sealed leadacid battery |
169 |
110 |
$5K |
| E0955 |
Cushioned headrest |
495 |
309 |
$5K |
| E2361 |
22nf sealed leadacid battery |
191 |
109 |
$4K |
| K0108 |
W/c component-accessory nos |
227 |
72 |
$3K |
| K0004 |
High strength ltwt whlchr |
313 |
227 |
$2K |
| E2374 |
Hand/chin ctrl std joystick |
391 |
234 |
$2K |
| E2622 |
Adj skin pro w/c cus wd<22in |
64 |
46 |
$1K |
| K0040 |
Adjustable angle footplate |
235 |
145 |
$858.57 |
| E0956 |
W/c lateral trunk/hip suppor |
89 |
31 |
$763.46 |
| E2613 |
Position back cush wd <22in |
39 |
25 |
$736.94 |
| E2611 |
Gen use back cush wdth <22in |
82 |
55 |
$664.92 |
| E2370 |
Pwr wc dr wh motor/gear comb |
233 |
132 |
$620.48 |
| K0001 |
Standard wheelchair |
89 |
71 |
$149.18 |
| E2603 |
Skin protect wc cus wd <22in |
20 |
13 |
$45.30 |