| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,729 |
2,495 |
$618K |
| S9999 |
Sales tax |
1,506 |
1,378 |
$305K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,788 |
4,442 |
$264K |
| E1161 |
Manual adult wc w tiltinspac |
1,444 |
1,293 |
$246K |
| E1028 |
W/c manual swingaway |
4,159 |
3,032 |
$240K |
| E1399 |
Durable medical equipment mi |
486 |
121 |
$187K |
| E0973 |
W/ch access det adj armrest |
1,227 |
994 |
$88K |
| E0955 |
Cushioned headrest |
1,831 |
1,670 |
$70K |
| K0823 |
Pwc gp 2 std cap chair |
419 |
416 |
$55K |
| E0978 |
W/c acc,saf belt pelv strap |
1,032 |
977 |
$20K |
| E0971 |
Wheelchair anti-tipping devi |
492 |
424 |
$19K |
| E2392 |
Solid caster tire, integrate |
287 |
246 |
$17K |
| K0005 |
Ultralightweight wheelchair |
12 |
12 |
$16K |
| K0004 |
High strength ltwt whlchr |
208 |
208 |
$12K |
| E2386 |
Foam filled drive wheel tire |
63 |
60 |
$7K |
| E2361 |
22nf sealed leadacid battery |
62 |
60 |
$7K |
| E2394 |
Drive wheel excludes tire |
119 |
111 |
$6K |
| K0019 |
Arm pad repl, each |
349 |
291 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
28 |
28 |
$3K |
| E2363 |
Gr24 sealed leadacid battery |
14 |
14 |
$3K |
| E0951 |
Loop heel |
167 |
142 |
$2K |
| K0040 |
Adjustable angle footplate |
35 |
29 |
$2K |
| E2366 |
Battery charger, single mode |
13 |
13 |
$1K |
| E0956 |
W/c lateral trunk/hip suppor |
23 |
13 |
$935.65 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$380.87 |
| E0961 |
Wheelchair brake extension |
12 |
12 |
$316.29 |