| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0739 |
Repair/svc dme non-oxygen eq |
276 |
264 |
$75K |
| E1028 |
W/c manual swingaway |
177 |
132 |
$50K |
| E2620 |
Wc planar back cush wd <22in |
69 |
69 |
$32K |
| E2605 |
Position wc cush wdth <22 in |
58 |
58 |
$14K |
| E2395 |
Caster wheel excludes tire |
39 |
39 |
$8K |
| E2387 |
Foam filled caster tire |
27 |
27 |
$6K |
| E2366 |
Battery charger, single mode |
25 |
24 |
$6K |
| E2386 |
Foam filled drive wheel tire |
13 |
13 |
$4K |
| E2361 |
22nf sealed leadacid battery |
12 |
12 |
$3K |
| E2394 |
Drive wheel excludes tire |
13 |
13 |
$2K |
| E0955 |
Cushioned headrest |
13 |
13 |
$2K |