| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0739 |
Repair/svc dme non-oxygen eq |
532 |
477 |
$333K |
| K0108 |
W/c component-accessory nos |
1,851 |
798 |
$304K |
| K0005 |
Ultralightweight wheelchair |
53 |
52 |
$120K |
| E1161 |
Manual adult wc w tiltinspac |
46 |
37 |
$71K |
| E1028 |
W/c manual swingaway |
831 |
525 |
$46K |
| E0971 |
Wheelchair anti-tipping devi |
337 |
278 |
$32K |
| E0955 |
Cushioned headrest |
379 |
320 |
$29K |
| E0973 |
W/ch access det adj armrest |
376 |
323 |
$27K |
| E2609 |
Custom fabricate w/c cushion |
14 |
12 |
$7K |
| E2607 |
Skin pro/pos wc cus wd <22in |
71 |
69 |
$4K |
| E0951 |
Loop heel |
94 |
89 |
$3K |
| E2361 |
22nf sealed leadacid battery |
19 |
14 |
$3K |
| K0040 |
Adjustable angle footplate |
160 |
132 |
$2K |
| E0961 |
Wheelchair brake extension |
196 |
163 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
26 |
25 |
$246.38 |
| E2213 |
Pneumatic prop tire insert |
76 |
76 |
$0.00 |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$0.00 |