| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1028 |
W/c manual swingaway |
349 |
307 |
$120K |
| K0108 |
W/c component-accessory nos |
120 |
106 |
$52K |
| K0739 |
Repair/svc dme non-oxygen eq |
992 |
881 |
$25K |
| E0973 |
W/ch access det adj armrest |
114 |
107 |
$15K |
| E0955 |
Cushioned headrest |
86 |
76 |
$12K |
| K0040 |
Adjustable angle footplate |
109 |
94 |
$11K |
| E2213 |
Pneumatic prop tire insert |
102 |
87 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
29 |
24 |
$4K |
| Z0160 |
|
31 |
25 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
103 |
96 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
44 |
43 |
$2K |
| E0961 |
Wheelchair brake extension |
14 |
12 |
$288.40 |
| E0951 |
Loop heel |
12 |
12 |
$255.78 |