| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0004 |
High strength, lightweight wheelchair |
1,862 |
1,378 |
$121K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
125 |
86 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
48 |
31 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
742 |
551 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
315 |
239 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
44 |
28 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
14 |
12 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
19 |
13 |
$566.89 |