| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
1,582 |
1,142 |
$3.19M |
| E2311 |
Electro connect btw 2 sys |
1,884 |
1,363 |
$1.12M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
511 |
349 |
$1.10M |
| E1012 |
Ctr mount pwr elev leg rest |
1,658 |
1,175 |
$782K |
| E1028 |
W/c manual swingaway |
5,275 |
3,005 |
$392K |
| E1161 |
Manual adult wc w tiltinspac |
1,116 |
870 |
$334K |
| K0823 |
Pwc gp 2 std cap chair |
4,406 |
3,618 |
$326K |
| K0005 |
Ultralightweight wheelchair |
424 |
272 |
$297K |
| K0821 |
Pwc gp 2 std port cap chair |
2,055 |
1,721 |
$182K |
| E2361 |
22nf sealed leadacid battery |
2,485 |
1,640 |
$173K |
| E2377 |
Expandable controller, initl |
1,622 |
1,172 |
$171K |
| E0955 |
Cushioned headrest |
3,091 |
2,284 |
$138K |
| E2313 |
Pwc harness, expand control |
1,588 |
1,141 |
$118K |
| E1002 |
Pwr seat tilt |
210 |
142 |
$118K |
| K0825 |
Pwc gp 2 hd cap chair |
959 |
794 |
$107K |
| E2620 |
Wc planar back cush wd <22in |
523 |
347 |
$103K |
| E2609 |
Custom fabricate w/c cushion |
351 |
197 |
$86K |
| E0973 |
W/ch access det adj armrest |
1,300 |
751 |
$66K |
| K0108 |
W/c component-accessory nos |
1,442 |
835 |
$61K |
| K0040 |
Adjustable angle footplate |
939 |
535 |
$36K |
| E0971 |
Wheelchair anti-tipping devi |
1,123 |
654 |
$27K |
| E2365 |
U1 sealed leadacid battery |
535 |
411 |
$24K |
| E2607 |
Skin pro/pos wc cus wd <22in |
189 |
150 |
$19K |
| K0739 |
Repair/svc dme non-oxygen eq |
893 |
720 |
$8K |
| E0990 |
Wheelchair elevating leg res |
156 |
89 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
466 |
319 |
$6K |
| E0951 |
Loop heel |
742 |
327 |
$5K |
| E0961 |
Wheelchair brake extension |
290 |
162 |
$5K |
| E2213 |
Pneumatic prop tire insert |
200 |
133 |
$4K |
| E2211 |
Pneumatic propulsion tire |
160 |
107 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
45 |
24 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
18 |
16 |
$2K |
| E2231 |
Solid seat support base |
24 |
13 |
$2K |
| K0195 |
Elevating whlchair leg rests |
363 |
299 |
$1K |
| E0954 |
Foot box, any type each foot |
25 |
12 |
$272.66 |
| E2601 |
Gen w/c cushion wdth < 22 in |
19 |
12 |
$208.16 |