| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
1,123 |
733 |
$172K |
| E1028 |
W/c manual swingaway |
1,303 |
899 |
$125K |
| E1399 |
Durable medical equipment mi |
67 |
30 |
$101K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,602 |
1,347 |
$36K |
| E0955 |
Cushioned headrest |
360 |
310 |
$21K |
| E0973 |
W/ch access det adj armrest |
29 |
25 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
71 |
52 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
33 |
27 |
$2K |
| K0040 |
Adjustable angle footplate |
18 |
14 |
$2K |
| E0960 |
W/c shoulder harness/straps |
13 |
12 |
$1K |
| E2213 |
Pneumatic prop tire insert |
22 |
12 |
$431.78 |