| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,575 |
1,061 |
$1.29M |
| E1028 |
W/c manual swingaway |
2,688 |
1,776 |
$216K |
| K0108 |
W/c component-accessory nos |
1,201 |
618 |
$145K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,033 |
2,341 |
$85K |
| E0955 |
Cushioned headrest |
784 |
606 |
$49K |
| E0973 |
W/ch access det adj armrest |
288 |
217 |
$20K |
| K0823 |
Pwc gp 2 std cap chair |
172 |
168 |
$17K |
| K0040 |
Adjustable angle footplate |
66 |
52 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
62 |
49 |
$3K |
| E1161 |
Manual adult wc w tiltinspac |
42 |
24 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
16 |
12 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
111 |
90 |
$2K |
| E1012 |
Ctr mount pwr elev leg rest |
27 |
25 |
$1K |
| E0960 |
W/c shoulder harness/straps |
21 |
14 |
$1K |