| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
637 |
623 |
$475K |
| T4541 |
Large disposable underpad |
1,751 |
1,720 |
$89K |
| K0739 |
Repair/svc dme non-oxygen eq |
441 |
434 |
$50K |
| E0973 |
W/ch access det adj armrest |
148 |
104 |
$23K |
| T4535 |
Disposable liner/shield/pad |
300 |
273 |
$19K |
| E0971 |
Wheelchair anti-tipping devi |
225 |
151 |
$17K |
| K0040 |
Adjustable angle footplate |
117 |
88 |
$14K |
| A6250 |
Skin seal protect moisturizr |
941 |
914 |
$13K |
| A4335 |
Incontinence supply |
950 |
936 |
$10K |
| E2213 |
Pneumatic prop tire insert |
124 |
123 |
$7K |
| T4523 |
Adult size brief/diaper lg |
56 |
49 |
$7K |
| E0960 |
W/c shoulder harness/straps |
53 |
39 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
64 |
51 |
$2K |
| T4527 |
Adult size pull-on lg |
12 |
12 |
$732.60 |
| E0961 |
Wheelchair brake extension |
13 |
13 |
$564.20 |