| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
440 |
318 |
$1.21M |
| E2311 |
Electro connect btw 2 sys |
531 |
380 |
$369K |
| K0823 |
Pwc gp 2 std cap chair |
3,140 |
2,391 |
$255K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
59 |
39 |
$185K |
| E1012 |
Ctr mount pwr elev leg rest |
508 |
373 |
$139K |
| E1028 |
W/c manual swingaway |
1,626 |
846 |
$99K |
| E2377 |
Expandable controller, initl |
442 |
320 |
$71K |
| E2361 |
22nf sealed leadacid battery |
1,018 |
733 |
$59K |
| E2313 |
Pwc harness, expand control |
430 |
301 |
$45K |
| E0955 |
Cushioned headrest |
711 |
516 |
$32K |
| K0821 |
Pwc gp 2 std port cap chair |
126 |
121 |
$28K |
| K0825 |
Pwc gp 2 hd cap chair |
155 |
112 |
$24K |
| E2620 |
Wc planar back cush wd <22in |
51 |
39 |
$14K |
| K0739 |
Repair/svc dme non-oxygen eq |
482 |
377 |
$5K |
| K0108 |
W/c component-accessory nos |
80 |
40 |
$4K |
| E2365 |
U1 sealed leadacid battery |
128 |
82 |
$4K |
| K0195 |
Elevating whlchair leg rests |
88 |
70 |
$52.90 |