| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
356 |
220 |
$88K |
| E1028 |
W/c manual swingaway |
1,516 |
509 |
$39K |
| E0955 |
Cushioned headrest |
549 |
344 |
$13K |
| E0973 |
W/ch access det adj armrest |
373 |
144 |
$10K |
| K0823 |
Pwc gp 2 std cap chair |
105 |
75 |
$7K |
| K0739 |
Repair/svc dme non-oxygen eq |
407 |
190 |
$3K |
| K0040 |
Adjustable angle footplate |
207 |
58 |
$3K |
| E2607 |
Skin pro/pos wc cus wd <22in |
18 |
13 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
180 |
43 |
$2K |
| E2361 |
22nf sealed leadacid battery |
35 |
16 |
$1K |
| K0108 |
W/c component-accessory nos |
40 |
13 |
$574.37 |
| E0951 |
Loop heel |
85 |
24 |
$525.19 |
| E2211 |
Pneumatic propulsion tire |
49 |
12 |
$339.68 |
| E0978 |
W/c acc,saf belt pelv strap |
50 |
15 |
$238.33 |
| E2213 |
Pneumatic prop tire insert |
49 |
12 |
$230.28 |