| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
134 |
125 |
$241K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
89 |
87 |
$26K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
171 |
169 |
$16K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
12 |
12 |
$11K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
83 |
82 |
$10K |
| K0040 |
Adjustable angle footplate, each |
111 |
110 |
$10K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
74 |
74 |
$5K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
12 |
12 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
54 |
54 |
$2K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
12 |
12 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
19 |
19 |
$688.00 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
15 |
15 |
$256.35 |