| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
544 |
538 |
$332K |
| K0108 |
W/c component-accessory nos |
741 |
679 |
$282K |
| E1028 |
W/c manual swingaway |
1,032 |
822 |
$145K |
| E0955 |
Cushioned headrest |
818 |
798 |
$50K |
| E0973 |
W/ch access det adj armrest |
371 |
316 |
$28K |
| K0040 |
Adjustable angle footplate |
307 |
288 |
$26K |
| E0971 |
Wheelchair anti-tipping devi |
518 |
492 |
$23K |
| T4541 |
Large disposable underpad |
744 |
731 |
$17K |
| E1225 |
Manual semi-reclining back |
77 |
77 |
$14K |
| E2620 |
Wc planar back cush wd <22in |
44 |
44 |
$12K |
| K0003 |
Lightweight wheelchair |
397 |
391 |
$12K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,628 |
1,433 |
$12K |
| E2607 |
Skin pro/pos wc cus wd <22in |
45 |
44 |
$8K |
| K0001 |
Standard wheelchair |
299 |
296 |
$6K |
| E0956 |
W/c lateral trunk/hip suppor |
46 |
41 |
$6K |
| E2231 |
Solid seat support base |
43 |
43 |
$4K |
| E0961 |
Wheelchair brake extension |
134 |
129 |
$4K |
| A4927 |
Non-sterile gloves |
341 |
198 |
$3K |
| E0990 |
Wheelchair elevating leg res |
15 |
14 |
$2K |
| K0195 |
Elevating whlchair leg rests |
696 |
683 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
58 |
52 |
$807.70 |