| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
10,676 |
1,957 |
$6.01M |
| K0108 |
W/c component-accessory nos |
3,816 |
1,879 |
$801K |
| E1028 |
W/c manual swingaway |
2,316 |
1,272 |
$244K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,707 |
2,114 |
$98K |
| E0955 |
Cushioned headrest |
661 |
486 |
$50K |
| E0960 |
W/c shoulder harness/straps |
395 |
291 |
$24K |
| E0973 |
W/ch access det adj armrest |
242 |
172 |
$14K |
| K0040 |
Adjustable angle footplate |
168 |
120 |
$9K |
| E0950 |
Tray |
178 |
113 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
334 |
261 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
51 |
40 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
16 |
12 |
$2K |
| E0951 |
Loop heel |
33 |
27 |
$607.66 |