| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2510 |
Sgd w multi methods msg/accs |
178 |
177 |
$779K |
| K0823 |
Pwc gp 2 std cap chair |
683 |
661 |
$325K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,367 |
3,183 |
$196K |
| E1161 |
Manual adult wc w tiltinspac |
495 |
490 |
$121K |
| K0108 |
W/c component-accessory nos |
910 |
681 |
$104K |
| K0005 |
Ultralightweight wheelchair |
88 |
88 |
$86K |
| E1028 |
W/c manual swingaway |
1,182 |
952 |
$71K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
17 |
17 |
$52K |
| E2361 |
22nf sealed leadacid battery |
371 |
371 |
$49K |
| E0955 |
Cushioned headrest |
817 |
811 |
$47K |
| E1007 |
Pwr seat combo w/shear |
13 |
13 |
$39K |
| E0973 |
W/ch access det adj armrest |
448 |
385 |
$35K |
| E2311 |
Electro connect btw 2 sys |
53 |
53 |
$32K |
| K0040 |
Adjustable angle footplate |
498 |
453 |
$30K |
| E2392 |
Solid caster tire, integrate |
276 |
255 |
$22K |
| E0956 |
W/c lateral trunk/hip suppor |
189 |
159 |
$21K |
| E1399 |
Durable medical equipment mi |
14 |
13 |
$20K |
| E2607 |
Skin pro/pos wc cus wd <22in |
131 |
129 |
$18K |
| E0971 |
Wheelchair anti-tipping devi |
373 |
335 |
$17K |
| E1012 |
Ctr mount pwr elev leg rest |
39 |
39 |
$14K |
| E2386 |
Foam filled drive wheel tire |
133 |
123 |
$14K |
| K0825 |
Pwc gp 2 hd cap chair |
15 |
14 |
$14K |
| E2394 |
Drive wheel excludes tire |
171 |
160 |
$12K |
| E2622 |
Adj skin pro w/c cus wd<22in |
50 |
50 |
$11K |
| E2374 |
Hand/chin ctrl std joystick |
39 |
39 |
$9K |
| E2613 |
Position back cush wd <22in |
29 |
29 |
$7K |
| E2370 |
Pwr wc dr wh motor/gear comb |
17 |
14 |
$6K |
| E2620 |
Wc planar back cush wd <22in |
40 |
40 |
$6K |
| E2366 |
Battery charger, single mode |
42 |
42 |
$5K |
| E0960 |
W/c shoulder harness/straps |
79 |
79 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
251 |
249 |
$5K |
| E2213 |
Pneumatic prop tire insert |
157 |
128 |
$5K |
| E2359 |
Gr34 sealed leadacid battery |
34 |
34 |
$4K |
| E2377 |
Expandable controller, initl |
16 |
16 |
$4K |
| E2313 |
Pwc harness, expand control |
17 |
17 |
$3K |
| E0951 |
Loop heel |
143 |
129 |
$3K |
| K0019 |
Arm pad repl, each |
142 |
141 |
$2K |
| E0961 |
Wheelchair brake extension |
17 |
17 |
$360.90 |