| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,768 |
1,529 |
$288K |
| E1028 |
W/c manual swingaway |
4,302 |
2,260 |
$173K |
| E1161 |
Manual adult wc w tiltinspac |
569 |
566 |
$142K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,550 |
2,415 |
$114K |
| E0240 |
Bath/shower chair |
24 |
24 |
$59K |
| E0955 |
Cushioned headrest |
1,129 |
1,117 |
$36K |
| E1399 |
Durable medical equipment mi |
42 |
13 |
$17K |
| E0973 |
W/ch access det adj armrest |
137 |
117 |
$10K |
| E2607 |
Skin pro/pos wc cus wd <22in |
38 |
38 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
190 |
187 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
55 |
52 |
$3K |
| E0960 |
W/c shoulder harness/straps |
53 |
49 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
26 |
25 |
$3K |
| K0823 |
Pwc gp 2 std cap chair |
12 |
12 |
$3K |
| K0040 |
Adjustable angle footplate |
12 |
12 |
$732.00 |
| E1225 |
Manual semi-reclining back |
12 |
12 |
$437.03 |
| K0019 |
Arm pad repl, each |
38 |
25 |
$303.39 |
| E0951 |
Loop heel |
14 |
12 |
$217.82 |