| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
265 |
190 |
$36K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
41 |
39 |
$30K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
42 |
40 |
$27K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
216 |
214 |
$22K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
429 |
275 |
$15K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
74 |
49 |
$9K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
226 |
217 |
$5K |
| K0040 |
Adjustable angle footplate, each |
12 |
12 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
14 |
14 |
$975.34 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
13 |
13 |
$156.60 |