| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,412 |
1,430 |
$1.56M |
| E1399 |
Durable medical equipment mi |
512 |
404 |
$1.32M |
| K0739 |
Repair/svc dme non-oxygen eq |
1,771 |
1,414 |
$107K |
| E1028 |
W/c manual swingaway |
4,769 |
1,746 |
$107K |
| E1161 |
Manual adult wc w tiltinspac |
885 |
678 |
$44K |
| E0955 |
Cushioned headrest |
1,709 |
1,357 |
$39K |
| E0973 |
W/ch access det adj armrest |
79 |
58 |
$5K |
| K0040 |
Adjustable angle footplate |
157 |
104 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
75 |
55 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
33 |
25 |
$3K |
| E0960 |
W/c shoulder harness/straps |
31 |
26 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
73 |
65 |
$1K |
| E0950 |
Tray |
13 |
13 |
$770.47 |
| E0951 |
Loop heel |
19 |
13 |
$225.54 |