| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
2,528 |
2,490 |
$5.34M |
| K0004 |
High strength ltwt whlchr |
1,824 |
1,812 |
$2.25M |
| E2607 |
Skin pro/pos wc cus wd <22in |
4,428 |
4,373 |
$1.06M |
| E0973 |
W/ch access det adj armrest |
4,964 |
4,883 |
$749K |
| E1225 |
Manual semi-reclining back |
1,744 |
1,717 |
$587K |
| E1028 |
W/c manual swingaway |
3,159 |
2,833 |
$494K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,371 |
1,360 |
$459K |
| E2613 |
Position back cush wd <22in |
1,150 |
1,133 |
$386K |
| E0971 |
Wheelchair anti-tipping devi |
4,928 |
4,841 |
$372K |
| E0955 |
Cushioned headrest |
2,628 |
2,573 |
$311K |
| E2620 |
Wc planar back cush wd <22in |
659 |
654 |
$292K |
| E0990 |
Wheelchair elevating leg res |
1,744 |
1,705 |
$283K |
| K0040 |
Adjustable angle footplate |
2,256 |
2,213 |
$271K |
| E0956 |
W/c lateral trunk/hip suppor |
1,549 |
1,462 |
$252K |
| K0053 |
Elevate footrest articulate |
1,285 |
1,271 |
$221K |
| E2231 |
Solid seat support base |
1,031 |
1,022 |
$150K |
| E2209 |
Arm trough each |
874 |
859 |
$134K |
| E0961 |
Wheelchair brake extension |
2,854 |
2,823 |
$127K |
| E2203 |
Frame depth less than 22 in |
279 |
279 |
$125K |
| E0951 |
Loop heel |
3,593 |
3,546 |
$108K |
| E2611 |
Gen use back cush wdth <22in |
470 |
470 |
$107K |
| E1226 |
Manual fully reclining back |
184 |
183 |
$59K |
| E2608 |
Skin pro/pos wc cus wd>=22in |
191 |
190 |
$56K |
| K0005 |
Ultralightweight wheelchair |
25 |
25 |
$42K |
| K0108 |
W/c component-accessory nos |
234 |
190 |
$40K |
| E2615 |
Pos back post/lat wdth <22in |
73 |
70 |
$28K |
| E2612 |
Gen use back cush wdth>=22in |
28 |
28 |
$10K |
| E0992 |
Wheelchair solid seat insert |
40 |
39 |
$2K |
| E2219 |
Foam caster tire any size ea |
14 |
14 |
$945.55 |