| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,123 |
733 |
$172K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,303 |
899 |
$125K |
| E1399 |
Durable medical equipment, miscellaneous |
67 |
30 |
$101K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,602 |
1,347 |
$36K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
360 |
310 |
$21K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
29 |
25 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
71 |
52 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
33 |
27 |
$2K |
| K0040 |
Adjustable angle footplate, each |
18 |
14 |
$2K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
13 |
12 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
22 |
12 |
$431.78 |