| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0739 |
Repair/svc dme non-oxygen eq |
1,178 |
1,083 |
$55K |
| K0108 |
W/c component-accessory nos |
113 |
100 |
$27K |
| E1028 |
W/c manual swingaway |
555 |
495 |
$26K |
| K0800 |
Pov group 1 std up to 300lbs |
15 |
14 |
$9K |
| E1161 |
Manual adult wc w tiltinspac |
199 |
197 |
$8K |
| E0955 |
Cushioned headrest |
393 |
387 |
$6K |
| E0973 |
W/ch access det adj armrest |
41 |
41 |
$1K |
| E0971 |
Wheelchair anti-tipping devi |
69 |
63 |
$1K |
| E2361 |
22nf sealed leadacid battery |
12 |
12 |
$1K |
| K0040 |
Adjustable angle footplate |
13 |
13 |
$663.19 |
| E0978 |
W/c acc,saf belt pelv strap |
42 |
42 |
$492.47 |