| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,300 |
1,581 |
$475K |
| E1028 |
W/c manual swingaway |
5,230 |
4,166 |
$374K |
| K0823 |
Pwc gp 2 std cap chair |
1,208 |
1,095 |
$222K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,463 |
3,720 |
$137K |
| K0004 |
High strength ltwt whlchr |
2,242 |
1,627 |
$113K |
| E0973 |
W/ch access det adj armrest |
934 |
711 |
$84K |
| E0955 |
Cushioned headrest |
1,155 |
974 |
$76K |
| E1161 |
Manual adult wc w tiltinspac |
108 |
89 |
$68K |
| E2374 |
Hand/chin ctrl std joystick |
37 |
26 |
$14K |
| K0040 |
Adjustable angle footplate |
106 |
86 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
192 |
155 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
320 |
243 |
$7K |
| Z0160 |
|
86 |
42 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
32 |
24 |
$4K |
| E2365 |
U1 sealed leadacid battery |
28 |
24 |
$3K |
| E0960 |
W/c shoulder harness/straps |
47 |
35 |
$2K |
| E2366 |
Battery charger, single mode |
15 |
12 |
$2K |
| K0019 |
Arm pad repl, each |
71 |
60 |
$965.40 |
| E2213 |
Pneumatic prop tire insert |
15 |
13 |
$431.15 |
| E0951 |
Loop heel |
12 |
12 |
$256.73 |