| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
856 |
498 |
$924K |
| K0823 |
Pwc gp 2 std cap chair |
3,514 |
2,393 |
$302K |
| E1002 |
Pwr seat tilt |
299 |
278 |
$184K |
| E2311 |
Electro connect btw 2 sys |
997 |
589 |
$155K |
| K0005 |
Ultralightweight wheelchair |
437 |
321 |
$151K |
| E1028 |
W/c manual swingaway |
3,576 |
1,745 |
$76K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
68 |
39 |
$65K |
| E2361 |
22nf sealed leadacid battery |
1,813 |
1,138 |
$55K |
| K0835 |
Pwc gp2 std sing pow opt s/b |
120 |
115 |
$44K |
| E0955 |
Cushioned headrest |
1,622 |
1,136 |
$30K |
| E1012 |
Ctr mount pwr elev leg rest |
708 |
402 |
$26K |
| E1161 |
Manual adult wc w tiltinspac |
374 |
315 |
$21K |
| E2313 |
Pwc harness, expand control |
816 |
472 |
$17K |
| E2365 |
U1 sealed leadacid battery |
345 |
296 |
$13K |
| K0108 |
W/c component-accessory nos |
276 |
157 |
$11K |
| E0973 |
W/ch access det adj armrest |
916 |
454 |
$10K |
| K0825 |
Pwc gp 2 hd cap chair |
83 |
76 |
$10K |
| E2377 |
Expandable controller, initl |
703 |
375 |
$7K |
| E2607 |
Skin pro/pos wc cus wd <22in |
241 |
171 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
874 |
410 |
$6K |
| E2611 |
Gen use back cush wdth <22in |
226 |
160 |
$5K |
| K0040 |
Adjustable angle footplate |
588 |
279 |
$5K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,012 |
740 |
$5K |
| E2366 |
Battery charger, single mode |
74 |
66 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
256 |
185 |
$2K |
| E0961 |
Wheelchair brake extension |
367 |
172 |
$2K |
| E2620 |
Wc planar back cush wd <22in |
40 |
28 |
$2K |
| E2603 |
Skin protect wc cus wd <22in |
128 |
115 |
$1K |
| E0951 |
Loop heel |
659 |
306 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
212 |
168 |
$1K |
| E2211 |
Pneumatic propulsion tire |
112 |
55 |
$493.76 |
| K0195 |
Elevating whlchair leg rests |
95 |
81 |
$229.92 |
| K0019 |
Arm pad repl, each |
21 |
13 |
$94.25 |
| E2213 |
Pneumatic prop tire insert |
91 |
41 |
$64.82 |